C 156 
L66 
opy 1 



LIBRPRY OF CONGRESS 



027 261 291 2 # 



A TREATISE 



-025T- 



Malarial Fevers, for Domestic Use, 

By J. M. LEWIS, M. D. 
MEXIA, TEXAS. 




DOMESTIC USE 




J. M. LEWIS, M. D. 

MEXIA, TEXAS. 




KUGK.NK VON BOKCKIIANN, BOOK AND JOB PRINTER, AUSTIN, TKXAS. 

1888, 



Copyright, 1888, by the Author. 



LC Control Number 




tmp96 029101 



PEEFACE. 



This little book on Malarial Fevers is written in plain 
language, (avoiding all technical terms,) in order that the 
non-professional man may understand how to manage the 
common forms of fevers of the South. 

I do not claim any originality in the ideas set forth, nor 
is there anything novel ; but having had much experience 
in the treatment of malarial diseases, and knowing of no 
work exclusively on fevers, for domestic use, and moreover 
recognizing the fact that fully three-fourths of the sickness 
of this country is malarial, and easily managed when thor- 
oughly understood, — for these and other reasons, — I propose 
to record all the essential facts in reference to Malaria and 
its influence on the human system, its cause, symptoms, 
treatment, and the best mode of prevention. Also describing 
the pulse, temperature, (use of thermometer,) respiration, 
etc., etc. 

A chapter is devoted to the symptoms and treatment of 
convulsions of children, occurring during an attack of fever. 



mTRODUOTORY. 



I would not attempt to delude any one with the idea that 
they may become expert in the treatment of Malarial Fe- 
vers, or that I can make Physicians of all who may read 
this work ; but will maintain that the facts herein taught 
are true ; and have been demonstrated time and time again. 
And if you do not learn how to manage an ordinary case of 
Malarial Fever after reading and studying closely this little 
book, the fault will be with you. 

To country people, who live many miles from a physician, 
this book will be valuable during the sickly season — ^July, 
August and September, in the South — as often they cannot 
obtain the services of a physician ; then a correct knowledge 
of how, skillfully, to manage the sick, is invaluable. The 
life of the patient is in danger, and whatever is adminis- 
tered, should be done intelligently. 

The nurse should have some idea of what the disease is, 
and what to accomplish by the remedies. 

Many intelligent country people know well how to treat 
an ordinary case of Malarial Fever — observation has taught 
them, and they seldom call a physician for such a case. 

In this book each type of the disease will be considered 
in a separate chapter. This is done for convenience. Fbst^ 
we can best study the disease in types, then as a whole. 



MAI.ARIAI. FKVERS. 



5 



Second, in cases of emergency, the reader can refer to any 
chapter at once. 

This book is not written to injure, in any manner, my 
professional brethren, and I hope none will think that it is 
imp} ofessio7ial in me to write it. 

The fact is, we often visit patients when it is plain that if 
the family had properly understood the case, a life could 
have been saved, and the remedies administered should not 
have been given. 

In such cases the thoughtful M. D. says nothing, avoids 
all comments, because he does not wish the family and 
friends to think, that by neglect or ignorance on their part, 
the patient died. This is more often the case in malarial 
sickness, than any other ; for in some instances it assumes 
great violence ; yet is generally controllable by proper treat- 
ment, if administered early. 

That the views set forth in this book, are not in accord 
with those held by many physicians, I well know; especially 
is this true of the oft-used remedy, calomel. In condemning 
its use in the acute stage of Malarial Fevers, I feel confident, 
after many years experience, that I am correct, and that its 
use entails much suffering and debility ; thereb}^ prolonging 
convalescence. This is also the opinion of some of the best 
authorities on Malarial Fevers, as I will show further on. 

In a book of this kind, I cannot argue this point at 
length, going into details as to its action, nor is it neces- 
sary ; thinking it can be safely said that the use of calomel 
in vialaiial sickness will soon be a thing of the past ^ as is 



6 



MAI.ARIAI. FEVERS. 



bleeding and other spoilative treatment, which came into 
use when the disease was regarded as inflammatory, and 
only holds its place now on account of its mpposed (?) action 
-on the liver. 



MAIvARIAI. FKVKRS. 



7 



FKVER THKRMOMKTKR. 



To properly understand fevers, and to be accurate in 
noting its phases, it is necessary to use a fever thermometer. 

There is no mystery in its use; it is simple and easily un- 
derstood, and while one may understand the case, often, 
without it, yet with accuracy much better with its aid. 

The day is not far distant when every family in the coun- 
try will be supplied with a fever thermometer, and it is well 
they should, for it certainly is one of the most valuable 
auxiliaries we have for diagnosing disease. 

I will try to explain fully, how to use the thermometer. 

To the physician it is indispensable, and all well-informed 
doctors use them ; indeed, we cannot find an intelligent M. 
D. in the country without one in his pocket. 

There are several kinds of these instruments in the mar- 
ket. All druggists and instrument makers keep them. 

The best, or rather the one I prefer, is the small, straight, 
self-registering, in rubber case. This one is convenient to 
carry, and generally accurate. 

Some thermometers are curved and some do not have the 
self-register. This latter (without a self-register) kind is 
not reliable, and one is likely to be deceived by it, for, in 
taking the thermometer from the arm-pit, (the part of the 
body to which it is usually applied,) it may fall a degree or 



8 



MAI.ARIAI. FKVERS. 



SO before you notice it ; especially is this true if the weather 
is cool. 

The main point in purchasing a thermometer, is to be 
sure it is correct. 

Always ask, if it has been tested. Should it be incorrect, 
of course, it would mislead you. 

Have your physician or some one test it with one that 
has been used and known to be accurate. 

Have no fear in commencing the use of the thermometer,, 
that you will not understand it. You will soon recognize 
its great value and simplicity. 

The normal (natural) temperature of the bod}^ is 98^°- 
The heat of the body varies to some extent in different per- 
sons, as it does in our own bodies, but from 98^° to 98 
is the average normal temperature of the human body, in 
health. 

Most of the thermometers have a "star" on them at98>4°, 
thus marking it as the normal temperature of the bod)^ 

In using a self-registering thermometer, always bring the 
mercury down to the ' 'star' ' before inserting in the arm-pit. 
Jarring the thermometer, which is readily done by holding 
the same in the fingers and then striking the knee with the 
hand, (as you perhaps have seen physicians do.) 

Be careful not to jar the mercury below the point 98}^°, 
as it may descend into the bulb [and become useless, for if 
the register ever passes into the bulb, the register is ruined. 

When the register is at the correct place (98^°), insert 
the bulb (or mercury part) in the arm-pit (axilla), exercis- 



MAI.ARIAI, FEVERS. 



9 



ing care that the mercury part is well covered with flesh, 
(otherwise you may be taking the temperature of the cloth- 
ing, and not the body), which can be done by placing the 
fore-arm across the breast. 

After adjusting the thermometer well, let remain at 
least five (5) minutes ; then note the height of the mercury 
in the column. 

It is always best to write down the hour and the degree 
of fever ; by doing this you can compare the fever one day 
with another. 

This is all very easy and simple to execute, nevertheless 
very important. 

RECAPlTUIvATlON. 

1. Procure a good, reliable, self-registering thermometer. 

2. See that the point of register is at 98}^° (star), before 
inserting in the arm-pit. 

3. Be sure that the bulb is well-covered with flesh. 

4. I^et the thermometer remain at least five minutes in 
the arm-pit. 

5. Mark the hour taken and the height of the fever. 

A little practice will soon make perfect in its use. I know 
many ladies, who understand the use of the thermometer 
well ; acquired the knowledge from attending one case of 
fever. 

In attending the sick learn to be systematic and accurate; 
they must be administered to cortcdly, or not at all. 

By keeping a correct register, noting the temperature 
every three or four hours, the nurse will soon obser\^e when 



lO 



MALARIAL FEVERS. 



the fever cools, and also the effect of the remedies given, 
etc.; can also compare the temperature of the body, one 
da}' with the next. 

I do not think it well, ever>' time, to inform the patient 
as to the amount of fever they may have, for in protracted 
cases the}^ are liable to become discouraged. The patient 
can be informed, if they inquire as to how much fever they 
have, by an evasive answer, stating, your fever is about the 
same as a certain time yesterday', or, not so much as a few 
days since, or less, as the case may be. If the nurse finds 
the patient watching the course of their fever, it is well not 
to use the thermometer often. Always deal truthfully with 
a patient, but often their minds should be diverted from 
self, and kept as cheerful as possible. 



PULSE. 

Will now consider the pulse, for the pulse, temperature 
and respiration are the A B C's in the treatment of fevers. 

The pulse is, as most people know, the radial artery, and 
can be felt with the finger, near the wrist. 

COUNTING THE PULSE. 

To count it accurately, open your watch, at the same 
time placing the index finger on the artery, then wait until 
the second hand of watch is opposite either of the figures 
TO, 20, 30, 40, 50, or 60, (which divides the minutes into 
six parts), then count the pulsations that take qlace before 



MAI^ARIAI. FEVERS. 



II 



the second hand reaches the next figure, multiplying these 
pulsations by six, and you have the number per minute. 
Some physicians hold the pulse and count for one minute ; 
but this is often tiresome to the patient, and by all means 
do not worry one when sick. Consequently, I think the 
above plan the best. 

Often it is best to place only one finger on the artery ; foi 
if you place two, the pulsations may confuse you. Do not 
press hard, just enough to get the impulse. 

The average rate of pulse in health, is about (68) sixty- 
eight for the adult, though this varies much in different in- 
dividuals, and with age and sex — faster in females than 
males. 

Usually the pulse beat will increase about five to ten 
beats for each degree of fever. Case with normal pulse o 
sixty-eight (68), when attack with fever, and temperature 
of body 102°, pulse will usually be from 100 to 105. With 
temperature of 103, pulse will be from 108° to 113°, and so 
on, though this will vary greatly in each individual. 

When in good health, the beating of pulse should be full 
and regular; no inte7missio7is. If any intermissions (stop- 
ping), it is proof that the heart is involved. 

Physicians are accustomed to describing the character of 
pulse, but in a work of this kind, perhaps it is best not to 
enter into details, as the subject is too scientific, and re- 
quires much study and investigation to properly understand. 

Note on your paper the hour and rate of the pulsations. 



12 • MALARIAL FEVKRS. 

as by this means the pulse rate can be compared one day 
with another. 

It is well to count the pulse and take the temperature of 
body at the same time. 

r:^capitulation. 

1 . Have the patient as quiet as possible when you count 
the pulse; let the arm rest eas}^ (in easy position). 

2. Open the watch, and, with the finger on the pulse, 
commence to count when the second hand is opposite one 
of the figures, as directed, 

3. Note if there is any intermission — missing of pul- 
sations. 

4. Make a record of the hour and rate of pulse, as well 
as temperature. 

N. B. — The artery is not alwa3^s found in the usual posi- 
tion near the wrist, it will vary in some. The anatom}^ of 
all are not alike. 



RESPIRATION. 

The normal respiration (breathing), is about seventeen 
(17) per minute. 

Some authorities give 3^, others 4 times the respiration 
for the pulse rate. That is, if a man breathes seventeen 
respirations to the minute, his pulse will be four times that, 
to-wit : sixty-eight. 

There can be no universal rule in these cases, but in a 
large majority, I think the rate given above, is correct. 



MAlvARIAL FKVKRS. 



13 



i. e., that there will be four beats of the pulse to each 
respiration; this is when the heart and lungs are acting in 
harmony (health). 

In counting the respirations, it is always best to do so, 
unobserved by the patient, for if the patient notices that 
his breathing is being counted, it will interfere with the 
same, and he will often force the respirations. The most 
favorable time to count the breathing is when the patient is 
asleep. 

Observe the same directions in counting the respirations, 
as directed for pulse, to-wit : Open the watch and note when 
the second-hand is opposite a given figure, then count each 
inhalation, until the same reaches the next figure, then mul- 
tiply, etc., (see directions for counting pulse). 

Do not count the exhalation, as the exhalations and in- 
halations constitute one respiration. 

In malarial forms the breathing is usually not much in- 
creased. Much is owing to the degree of restlessness and 
nervousness of the patient. In ordinary cases one to two 
respirations for each degree of fever. In congestive forms 
of fever the breathing is often rapid and sighing, and in 
some cases labored (forced). 

RECAPITULATION. 

1. The average normal respiration in an adult is seven- 
teen (17), faster in females, and more rapid in children. 

2. Count the respirations unobser\'ed (when possible), 
by the patient. When asleep is the best time. 



MAIvARIAL FKVKRS. 



3. Count by the watch as directed for pulse, and only 
count inhalations. 

4. In ordinary cases of Malarial Fevers the respiration 
is usually increased one to two respirations for each degree 
of fever ; in congestive more rapid. 



GENERAL REMARKS. 

Before commencing the study of Malarial Fever, it is 
proper to discuss how and Avhen to administer medicine. 

In administering remedies to the sick, we should have a 
definite object in view. 

There is no such thing in the practice of medicine as 
specifics, that is, a given remedy for each disease. Nature, 
or the naturaFworkings of the system, affects the cure. 

All the physician can do, is to rightly interpret nature, 
and assist in the work. 

Some people, (and I fear some physicians also,) seem to 
think that their remedies effect the cure. Not so. Then 
always be sure you do not retard nature's work, instead of 
assisting it. 

As s dd in the first of this book, try and be accurate. Mark 
on a paper the amount and kind of medicine given, also 
note the effect. This is very important, for in your excite- 
ment, you may forget. By all means, avoid excitement in 
the sick room. Be as calm and cool as possible. 

Often the [physician is told, on entering a room, in reply 
to the question, "what have you given?" "Oh! we have 



MAI^ARIAIv FEVERS. 



15 



given everything we know of, and the patient continuing to 
get worse, have sent for you." 

This is no information to the physician. He wants to 
know exactly what has been done, so always state exactly. 
Tell him you gave opium at a certain hour, quinine at a 
certain time, pills, etc., just as the facts may be. 

If the nurse has been careful, and noted all this on paper, 
just hand him the sheet, and at once he knows 3^our line of 
treatment. 

To show how easy it is to make a chart, the following is 
an example of how a record should be kept. It is not hard 
to learn, and any one that adopts it will soon acquire sys- 
tem. There is nothing like systematic work in any kind of 
business, and this holds good in the practice of medicine 
also: 



John Smith," (sick.) 



Day. 


Hoii} . 


Tempetatu} e. 


Pidse. 


Respu ation 


Oct. I, 


8 a. m. 


100 


100 


20 




12 m. 


102^ 




23 


( ( ( ( 


3 P- m. 


104 


130 


25 


( ( ( ( 


9 p. m. 


ICQ 


100 


20 


( < ( ( 


12 p. m. 


98)4 


68 


17 



This is a form of chart, and shows at a glance the condi- 
tion of John Smith for October ist, one day. 

Now, on another paper, note the time and kind of medi- 
cine given, with any remarks, as follows: 

John Smith was taken sick October ist. 8 a. m. gave a 
dose of compound cathartic pills. At 12 m. gave a dose o^ 



1 6 



MAI.x\RIAIv FKVKRS. 



salts. At 3 p. m. gave a dose of bromide potassa. At 9 p. 
m. commenced giving quinine, in five grain do.ses, and have 
repeated every three hours. 

Remarks. — Bowels acted well two or three times. Sweat- 
ing freely at 6 p. m. Bowels acted again at 10 p, m., etc., 
etc. Under the head of remarks, note anything about the 
patient; if restless, how much he slept, and kind of sleep, 
etc., etc. 

Do not make your notes in the sick room. If patient is 
very sick, it is well to write what he may say. Especially 
is this true of cases wounded, as it may be used as evidence 
in the courts of the country. I will remark incidentally, 
that statements made by wounded persons are not good evi- 
dence, unless they have been informed, or state that they 
are going to die. The dying statement then is good evi- 
dence. 

By the use of such a record (chart) as I have given, it is 
:an easy matter to see just what the patient has taken, and 
the record of fever can be compared, one day with the next, 
etc. 

Always ask your doctor to write his directions plainly, 
and let you know just what he is giving. 

The old idea that the patient or nurse must not know the 
kind or quantity of the medicine, is exploded. Let the 
physician state what the remedy is, and what he expects to 
accomplish from its use. 

If a record was kept of every dose and the quantity, (as I 
suggested,) some people are forced to take during a spell of 



MAI^ARIAI, FEVERS. 



17 



sickness, it would be surprising that they ever recovered. 
Then there can be no question, but that often there is more- 
drugs used than is necessary. Every day the profession are 
using less medicine, and often now cases are treated without 
the aid of so much drugs. But the people seem determined 
to poison their system, and the patent medicines are bought 
and consumed in this country by the car load. 

The large majority of medicine sold are foreign to the 
S3^stem, and should be administered with care. 



MALARIA. 

Definition. — "An unknown poison of telluric origin,, 
the cause of the periodic fevers." — (Sternberg.) 

It is impossible to say just what malaria is : as no chem- 
ist or microscopist has ever been able to demonstrate it ; yet 
we know from its effect, and from places known to be mala- 
rial that it is a poison — and the difinition above given is a 
very good one — "The cause of the periodic fevers." 

In this country all the fevers that come and go (periodic) 
we ascribe to malaria. 

' 'A poison which is known only by its effects is necessari- 
ly a hypothetical substance, and yet there are not wanting 
those who deny altogether the existence of such an entity 
as malaria, and w^ho would account for the disease common- 
ly ascribed to the action of this poison, by the supposition 
that they are due to immaterial causes, such as refrigera- 
tion, electricity^ etc., etc." 



i8 



MAI.ARIAI. FKVKRS. 



This manner is not satisfactor}', and the belief in tlie 
poison as the cause has foundation, and one who has studied 
the subject closel}- must believe that a poison is under cer- 
tain circumstances generated, which substance, for want of 
a better name, we call malaria. 

While we are ignorant of its true character, we are con- 
versant with its effects. The general belief is that it is 
atmospheric (a gas). 

Men are slow to confess ignorance on any subject, but 
candor compels us to admit that malaria, or the substance 
that enters the human system and causes our periodic fevers, 
has never been seen nor demonstrated. Yet the almost 
universal belief is that it is a material agent, and all mala- 
rial fevers are classed as infectious and due to a specific 
cause — i. c, a poison introduced into the system from 'with- 
out. 

Much time and close labor has been spent in trying to 
solve the question, but so far all the skill of the chemist 
and microscopist have been in vain. 

Malaria, then, is undoubtedl}- a poison, a real substance, 
generated by a due mixture of heat and moisture, intensi- 
fied by vegetable decomposition, which, entering the human 
S3'stem, causes periodic fevers. 

CAUSES — WHICH PRODUCE MALARIA. 

In a work of this kind it will not be expected that I will 
be very elaborate in treating under this head. 

As stated in the chapter on malaria — the cause is un- 
doubted heat and moisture, with vegetable decomposition 



MALARIAL FEVERS. 



19 



Usually, if we know the cause of the sickness, it leads to a 
correct knowledge of the treatment, but in malarial sickness, 
as the cause is atmospheric — or rather the poison is in the 
atmosphere — it will be a difficult matter to remove the cause; 
so we are forced many times to remove the patient to a more 
congenial climate. 

We have several forms of malarial fevers, and yet all 
caused from the same poison, i. e. malaria. 

Why the one and same substance will produce a chill add 
fevey in one, remitteyit fever in another, and congestioii in an- 
other, is a question the profession can not answer. Yet we 
know from experience that such is the case. I need not 
state the reason for this conclusion, but state it as a well- 
known fact. We cannot see or handle malaria, yet it un- 
doubtedly is atmospheric and enters the system at night. 
When we are asleep the system becomes relaxed and then 
poison enters ; during sleep, the powers of life being to 
.some extent dormant, and resistant at its lowest ebb. 

This poison, which we call malaria, arises from the ground 
at night, in marsh}' places, it being more intense ; when 
the sun arises in the morning it is dispelled. Consequently 
there is no danger from exposure, in a malarious district, 
during the da3^ 

Prof. Flint makes the following statement in reference to 
the causation of malaria : 

1. It affects, b}' preference, low and moist localities. 

2. It is almost never developed at a lower temperature 
than 60° Fahr. 



20 MAI^ARIAL FEVERS. 

. — . t, 

3. Its evolution or active agency is checked b}' a tem- 
'perature of 32° Fahr. 

4. It is most abundant and most virulent as we approach 
the equator and the sea coast. 

5. It has an affinity for dense foliage, which has the 
power of accumulating it, when laying in the course of 
winds blowing from malarious localities. 

6. Forests or even woods have the power of obstructing 
and preventing its transmission under these circumstances. 

7. By atmospheric currents it is capable of being trans- 
ported to considerable distances, probably as far as five 
miles. 

8. It ma}^ be developed in previously health}' places b}^ 
turning up of the soil, as in making excavations for the foun- 
dations of houses, tracts for railroads and beds for canals. 

9. In certain cases it seems to be attracted and absorbed 
by bodies of water lying in the course of such winds as 
wafts it from the miasmatic source. 

10. Experience alone can enable us to decide as to the 
presence or absence of malaria in any given localit5\ 

11. In proportion as countries, previously malarious, are 
cleared up and thickly settled, periodic fevers disappear, 
in many instances to be replaced by typhoid fever. 

I have quoted at length from Professor Flint's work, be- 
cause these propositions are plain, and convey the idea so 
truthfully that malaria is a poison, generated by heat and 
moisture at a certain temperature (not less than 60° Fahr.), 
and the same is destroyed by cold (32° Fahr.), though in 



MALARIAL FEVERS. 



21 



our Southern States we undoubtedly have some malaria 
during almost ever}' month of the 3'ear. In this connection, 
I will state that I believe the pneumonias of this country' 
are effects, or often caused b}' malaria, and often relieved b}' 
the anti-malarial treatment. 

It is a fact, that families who seem to have most mala^iai 
fevers during the summer and fall, have pneiunonias during 
the winter. Quite a number of articles have appeared in 
medical journals, written to prove that it is one and the 
same poison that causes malaiial fevejs 2Cii^ pneitmonias. 

It is hard to convince some of my old Texas friends that 
the night air is unhealthy, and that sleeping exposed to 
same (when malaria abounds), will result in an attack of 
malarial fever. The}' contend that they were accustomed to 
sleeping in the open prairie (at night) for 3'ears, and never 
enjoyed better health. This is true; but it was before the 
country was settled, and while the prairies were covered 
with grass. The soil had not been turned up, and exposed 
to the ra3's of the sun. 

Formerl}-, in this country, the only places known to be 
malarious were those near the swamps, low, marshy lands 
and washouts. 

It is claimed b}^ some, and no doubt true, that one of the 
fruitful causes of malarial attacks is the water drank. Es- 
pecially is this the case with springs, shallow wells and 
tanks, while those who use pure cistern water escape. 

This is positively denied by others. I am not positive 
■myself, and cannot say whether the water drank is the 



22 



MALARIAI. FEVKRS. 



cause of malarial attacks or not — whether it is due to the 
presence of the poison in the atmoshpere, or in the water. 
i\s there is doubt upon the subject, I certainly think the 
patient should have the benefit, and cistern water, which is 
recognized (in this countr}^,) as the purest drinking water,, 
should be procured for one sick with malarial fever. Im- 
pure water, no doubt, debilitates the system, thus low^ering 
the vitality, and in this way may make the subject more 
susceptible to malarial influences. 

Professor Joseph Jones, in his "Memoirs," says: "The 
waters of low, swampy lands and rice fields are impregnated 
with organic matters, which, in certain seasons of the 3"ear, 
and under certain conditions, exert most deleterious in- 
fluence upon the health of the inhabitants. The great mor- 
tality upon rice places, many of which decrease instead of 
increasing, is due to the character of the • waters, which in- 
duce bowel affections, and degra3mient of the blood, and low 
grades of fever. ' ' [I suspect he means increase where he 
has written decrease above, and vice vosa. — L.] 

Professor Jones recommends cistern water for well and 
spring water. 



MALARIAL FEVERS. 



23 



SYMPTOMS AND COURSE OF CHILL AND FEVER. 



N'ames: Intermittent Fever, Chill and Fever, i\gue. 

Syraptoms: In all well marked cases there is no difficulty 
in forming an opinion as to Ague; most people in this 
country are familiar with the symptoms. 

It is characterized by parox3'sms of fever, running 
through certain definite stages, and occurring at more or less 
regular inten'als, with intermediate periods of rest. 

In discussing the S3anptoms of Intermittent Feve) , we will 
describe the three stages in the order in which the}' usuall}^ 
occur: 

First — Cold Stage. — The cold stage is generally ushered in 
by yawning and stretching; often the patient recognises the 
fact that he is going to have a chill. Yet, in a large ma- 
jority of cases, the attack is sudden, the patient suffering 
with pain in head and bones. Yawning, loss of appetite > 
general sense of illness. This ma}' be followed by fever, and 
have no decided chill, or cold stage, and often the patient is 
mislead as to the true nature of his disease. This is 
especially true of the first paroxysm, but generally the sec- 
ond is more decided. 

In the first paroxysm (attack) there may be no aching, 
and not much fever follow. The patient does not take his 
bed, continuing his business, or w^ork; but on the following 



24 



MAI.ARIAI, F5:VKRS. 



day, about the same hour, or earlier, he experiences a de- 
dided chill, followed with fever of several hours duration. 

When he has a decided chill, he is cold, (yet the ther- 
mometer in armpit ma}^ show heat of body,) has pain in 
bones, headache, cold waves up and down the spine, shiv- 
ering, the teeth chattering, skin looks rough, the patient 
is in a rigor, and shakes. This is what we call the "Arkan- 
saw Shake." 

The pulse is usually small, and anxiety depicted on his 
countenance, in some instances lividity, lips and fingers 
blue. 

He wants plent}^ of cover on his body, and yet the cold 
waves continue. This cold stage ma}^ last only a few 
minutes or an hour, generally about forty minutes, then fol- 
lows the hot stage, one passing into the other gradually. 
Often the duration and intensity of the cold stage, indicates 
its severity. 

When there is much lividity of the surface, and the tips 
and fingers blue, vomiting, wdth some pain in the chest and 
head, it indicates congestion. When these symptoms occur 
with children, they are liable to have convulsions. 

In the congestive form, death may take place soon after 
the patient is taken with the chill. I have known death to 
occur in two hours after the first s3'mptom of the chill, his 
body rapidly l)ecoming cold and livid. He soon passes into 
a deep comato.se condition, from which he cannot be aroused. 
No reaction taking place, death soon closes the scene. 

I have .seen this occur so often, that I always try to im- 



MAI^ARIAL FEVERS. 



25 



press upon my patients the importance of taking remedies 
early, in order to avoid the second paroxysm; for generally 
we do not have a congestive one at the first parox3'sm, nor 
is there anything to Avarn us that the second or third is 
liable to be a congestive chill. 

Usually, in this countr}', the most cases of congestion oc- 
cur ea.rly in the season, among the first cases of fever, and 
many deaths occur from neglecting to take proper remedies 
in time. So always tr}^ to check a chill and fever as soon 
as possible, for fear of congestion; for every chill and fever 
the patient has racks his S3'stem, producing changes in the 
blood and organs of the bodj^ making it more difficult to 
treat. 

Some people seem to have no fears of chills and fevers, 
and will not try to check the same, expecting to wear them 
•out. 

I have made it a rule for years, v^hen a patient applies to 
me for treatment for ague, to stop the paroxysm at once, 
fearing the next may be a congestive chill, and knowing 
the damage done the system by repeated attacks even of the 
ordinary ones. 

HOT STAGE — OF INTERMITTENT FEVER. 

The cold stage passes gradually into the hot, the pulse 
becomes quick, the chilh' sensations cease and the body be- 
comes warm, the head and bones ache ; in fact, the patient 
will inform you that he aches from the top of his head to 
his heels. 

The thermometer, applied to axilla, vv'ill show, perhaps, 



26 T.IALARIAI. FKVKRS. 



about io2° of fever, which continues to rise until it reaches 
104 or 105°. 

The urine becomes scanty, water is drank freely, and often 
as soon as it becomes warm in the stomach, is ejected. 

The eyes are injected and sparkling, the face flushed, de- 
lirium often accompanies this stage, and with children con- 
vulsions often occur. The child Vv^ll often sleep, and when 
aroused seem frightened and always very nervous. 

Fever affects no two alike — some will lie quiet and sleep 
the fever off ; with others only a moderate fever, 102°, w^ill 
cause delirium and the patient will be difficult to control, 
talking rapidl}^, and often it will be difficult to keep him in 
bed. 

The practice of former 3- ears w^as not to allow water dur- 
ing the hot stage, but the modern and correct practice is to 
allovv^ Vv^ater drank freely. 

I aUvays give my patients water or lemonade, with a small 
allowance of ice. (I think harm ma}^ be done by using the 
drinks too cold.) 

Even if the patient vomits the same it cools the stomach 
and produces free perspiration. 

The fever, [or hot stage, iLsually lasts about four hours, but 
in some instances more than twice that time. 

With children there is always danger of convulsions, un- 
til the fever commences to cool. 

When the fever is subsiding the skin becomes moist and 
cool, the pulse soft, and the thirst is not so 'great. 

In some instances, when the fever is high, the skin is 



MALARIxlL FEVERS. 



27 



moist, but alwa^'S hot under the moisture ; but, usually, the 
surface is hot and dr>^ during the paroxysm of fever. 

vSWEATiNG STAGE — OF INTERMITTENT FEVER. 

Now comes the calm after the storm — as the fever begins 
to subside, the skin becomes moist and the surface cool, 
sweating breaks out about the forehead, gradually extend- 
ing over the whole body, and soon the patient is bathed in 
a profuse prespiration. 

The head-ache disappears, the thirst is abated, and the pa- 
tient feels easy but weak, usually falls into a quiet sleep ; 
with this ends the paroxysm. 

In young children the cold and sweating stages are not 
so distinctly" marked as in the adult. 

The above finishes the discription of an ordinary chill 
and fever. Most of us in this country have experienced the 
same. After a rest of twelve (12) to twenty-four (24) hours 
the chill and fever may and most certainly will (unless ap- 
propriate treatment be instituted) return with force, and per- 
haps more intense than the first one. 

TREATMENT — (OF CHILE AND FEVER). 

First — Let the nurse be satisfied of the nature of the case, 
i. that the patient has ague. Most people in this 
country are so familiar with the symiptoms that there is of- 
ten no doubt in their minds as to the illness, and they sel- 
dom make a mistake. 

Cold Stage — There is no special treatment to be given 
during the cold stage, and often none necessar}-, as it cannot 
be cut short. 



28 



IvlAIvARIAL FEVERS. 



Placing the patient in bed, applying bottles of hot water 
to bod}', bathing the feet and legs in hot water and mustard, 
iisuall}- moderate the symptoms to some extent. 

Hot drinks are not admissible; the}- usuall}' do more 
harm than good. A dose of Hj'drate of Chloral, (15 to 20. 
grains,) is often given to an adult. This is a good remedy, 
and will relieve the head and back ache, and to some extent 
stop the rigors; but chloral is not a safe remedy in the 
hands of the people. 

Chloroform, administered intemall}^ (one-half teaspoon- 
ful, well diluted,) will lessen the rigors, and relieve all the 
disagreeable S3'mptoms, but chloroform is another one of 
those remedies that should be administered with care, and 
generally onl}' by a physician. 

In a work of this kind, (written for the people,) during 
the cold stage of /;z/<f?;;/zV/(??^/ /^'z'^/, I recommend only the 
common domestic remedies. 

The room should be well ventilated, applj' hot applica- 
tions to the body, plenty of cover to the patient, with hot 
water and mustard to feet and legs. 

If patient complains of pain in stomach, and it is loaded, 
fchill just after a meal,) it is well to administer an emetic — 
a glass of warm water and salt, or warm water and mustard. 
After the stomach is well emptied, if nausea should con- 
tinue, small doses of morphine (1-16 gr.) will relieve the 
same. In fact, morphine, while it quiets the stomach, will 
also relieve the ner\'ous system, and afford great relief, often 



MALARIAI^ FEVERS. 



29 



shortening the chill and lessening the duration of the hot 
vStage. 

Should the cold stage continue, and the patient become 
prostrated, his skin blue and cold, restless and vomiting 
congestion has taken place, and it will be well to use whis- 
key, or brand}^, and quinine freel}', giving a wine glass of 
whiskey, or brand}'-, with five grains quinine, and repeat in 
one-half an hour, if necessar}\ If the stomach will not re- 
tain it, inject in the bowels. This dose should be repeated 
every half hour, with mustard to the stomach and bowels, 
until the chill, or cold stage, ceases, and the hot stage com- 
mences. Often the patient will die in this cold stage (con- 
gestion,) in two or three hours, unless active means are used 
to bring about reaction, such as mustard to the surface, 
whiskey and quinine internally, with small portions of mor- 
phine to relieve nausea and restlessness. 

If bowels are constipated, I usually administer either 
saline cathartics, or use the sj^ringe, with warm water and 
soap — in some instances doing both, using the sj'ringe to 
hasten the action of the saline cathartics. 

The best salines are either epsom salts or seidlitz powders. 
If bowels are-hard to act on, compound carthartic pills (im- 
proved) are better, (dose 2 to 3). They are a splendid 
cathartic pill, and contain no calomel. 

I have now fully stated what may be necessary to do, un- 
der certain circumstances, in the cold stage; yet in the large 
majority of cases there is no necessity of any treatment for 



30 



MAI^ARIAI, FEVERS. 



the patient, as the cold stage only lasts a short time, and 
causes no great amount of suffering. 

Hot Stage — {Fevei) — The chill, (as stated), usually lasts 
but a short time, and then follows the fever. 

If the patient's stomach is quiet, and can retain quinine, 
I usually give one capsule, containing five (5) grains, and 
repeat everj^ three or four hours, using about fifteen grains 
of bromide potassa with each dose. 

Bromide Potassa is a safe and simple remedy, one that 
can be used without any danger. It prevents the quinine 
from affecting the head. Bromide Potassa is a remedy I 
always use in the treatment of malarial fevers, in the dose 
of 10 to 15 grs., repeated every three or four hours during 
the hot stage. 

Give the patient cold drinks — either lemonade or ice wa- 
ter — using care not to take too large quantities at a time ; 
small sips to quench the thirst ; large draughts chill the 
stomach, and are liable to do much harm, while small 
quantities of cold water or cold lemonade allay the thirst, 
and act on the skin and kidne^^s. 

Many physicians do not use any quinine during the hot 
stage of an intermittent fever, but wait until the fever sub- 
sides and the patient commences to perspire freely, but my 
practice has always been to give quinine (when the stomach 
will retain it) during the hot stage, and I have seen no 
cause to regret it 

Applying cloths with cold water to the head, is very 
grateful. Protecting the bed with an oil cloth and laying 



:\IALARIAL FEVERS. 



31 



the patient's head on same, then pouring the water over the 
head, will often relieve the pain in the head and is very re- 
refreshing. 

Sponging the bod}' well and using saline cathartics (if 
necessary to move the bowels) will lessen the fever. 

There is no necessity for preparing the system for quinine. 

It is well to open the bowels, especially if they be con- 
sticated, and in doing so it relieves the portal s^-stem. liver, 
spleen and kidneys ; this, according to my judgment, is best 
done b}' saline cathartics. 

I always give quinine to children in the hot stage: when 
the}- are very ner\'0U5 use large doses of bromide potassa at 
the same time. 

If the}' are threatened with spasm, give either chloral 
with the bromide potassa or use bromidia. 

Flint, in his excellent work on practice, recommends wait- 
ing imtil the fever subsides and the sweating commences, 
before using quinine. He then gives it in large doses : to 
an adult 15 to 20 grs., but I prefer smaller doses, repeated 
as above suggested. The quinine is the sine qua non in the 
treatment of chill and fevers; this is conceded by all author- 
ities. 

The bromide potassium should always be given to child- 
ren to prevent convulsion. 

Siccating Sta^c .—^^\\^\\ the fever subsides, the patient 
begins to sweat freely, his skin is cool, pulse soft— all the 
aches and pains disappearing ; he feels weak and will often 
sleep. This stage requires no special treatment, but an ef- 



32 



MALARIAL FKVERS. 



fort must be made to prevent a recurrence of the paroxysm. 

While it is the practice of many physicians to administer 
large doses of quinine in this stage, I much prefer 5 grain 
doses (for an adult, children in proportion) every two or three 
hours, until the patient is thoroughl}^ cinchonised, then 
make the doses less frequent, 5 grains every 5 or 6 hours 
and continue this for four or five days. 

If the appetite is poor, using a tonic of iron and quinine 
(see general remarks on the treatment of malarial fever). 

The bowels should be kept open, at least one action from 
same a day, avoiding any remedy that will debilitate the 
S3\stem. 

The patient will require sustaining remedies, for chills 
and fever ahvays debilitate and tend to break down the S)^s- 
tem, consequently we must build up, using no remedy that 
will weaken him. Keep in view the fact that the patient is 
poisoned with malaria, and that quinine is the antidote. 

If the sweating is profuse and the patient weak from the 
same, give a stimulant, either whisky or brandy. 

Note. — Care should be exercised in administering qui- 
nine to a lad}^, when pregnant, as large doses may cause her 
to miscarry. Quinine will do this in some cases. The best 
plan is to give in doses of two or three grains and repeat 
every three or four hours, and if any pain is excited in the 
womb, give either laudanam (15 drop doses) or morphine 
(/s to '4 grs.) 

Much care must be exercised in treating such cases with 
quinine. Some physicians doubt quinine possessing oxytoxic 



MAIyARIAI, FEVERS. 



33 



power, but I am firmly convinced it has, especially when 
given in large doses. 

Period of Intermission. — This is the time to thoroughly 
saturate the system with quinine. Do not let the patient 
overload his stomach with food, for in some cases the appe- 
tite is ravenous. 

Watermelons, apples, peaches and such articles are injur- 
ious and should not be allowed. A bland nourishing diet 
is all that is necessary. Keep the bowels open. If any 
diarrhoea, it should have appropriate treatment. 



REMITTENT FEVER. 



SYMPTOMS AND COURSE. 

Name. — Remittent Fever — Bilious Fever. 

Definition. — "A paroxysmal fever of malarial origin, 
which differs from malarial intetmittent fever voL2\.VL\y in the 
fact that the hot stage is more prolonged, and is not followed 
by an interval of complete absence of fever ; and that the 
cold stage is commonly ill defined or entirely absent, except 
at the outset. In severe cases gastric irritability and bilious 
vomiting are common symptoms." — (Sternberg.) 

They are a class of malarial fevers characterized by re- 
missions and exacerbations^ but without intermissions. 

The name remittent alludes to the remission or cessation of 
the febrile symptoms. 

There is not that distirct intermission as in inttfmittent 



34 



MALARIAI. FEVERS. 



J'evei , but a 7Cviission or dimhuition of the febrile symptoms. 

Often a chill and fever, if allowed to run their course un- 
checked, ma}' assume the remittent form. 

The attack in remittent form is usually gradual, com- 
mencing with aching of the head, back and bones, a feeling 
of illness ; this will sometimes amount to a rigor, with 
chilly sensations, soon followed b}^ flashes of heat of the 
surface. 

The thermometer applied at any time (even during the 
rigor) will show an elevation of temperature. 

The pulse is small and generall}' accelerated, the breath- 
ing irregular and sighing, the patient often restless ; vomit- 
ing soon sets in. 

As to these symptons, they vary much, as much depends 
upon the patient ; fever affecting no two alike ; some will 
lie quiet and sleep when they have fever, while others are 
restless and somewhat delirious. 

The tongue is usually coated with a white fur, the mar- 
gin is red and often indented by the teeth. Some physicians 
regard this mdentation by the teeth as a sure test for mala- 
rial fevers. 

While I do not la}- as much stress on this symptom as 
others, 3'et I freel}' admit that it is a good indication of ma- 
laria in the system. There is a mawkish taste — appetite 
gone — water and cold drinks being alone craved. 

The fever usually runs its course from ten (10) to twenty- 
four (24) hours ; then comes a remission. 

That is, the fever subsides to perhaps 99)^ or 100°, the 



1MAI.ARIAI, FEVERS. 



35 



skin becoming moist, but unless appropriate treatment is 
adopted, the fever will soon return and will be more intense) 
so we have almost a continued fever. 

Sometimes it is difficult, espcially at the commencement 
of an attack, to know whether the fever is malarial remit- 
tent or typhoid. 

In typhoid fever the temperature is usually loo to ioi° in 
the morning, and seldom over 102 to 102^/^° in the afternoon. 

In remittent fever, during the remission, the fever may 
be as low as 99/4°, or even normal ; it soon rises, 
however, to 104 or 105°. In remittent fever the fever is 
more intense, with aching of head, back and bones, while 
in typhoid fever, usuall}^, there is no pain. 

In remittent fever the bowels are generally constipated, — 
in typhoid, the bowels are tender and loose. 

In remittent fever there is often a sense of oppression in 
the stomach, and usually vomiting ; yellowness of skin is 
also common, w^hich, with a coated tongue, often leads phy- 
sicians to sa}^ that the liver is the cause of the fever and 
that the patient is bilious. 

True, the liver is affected, but not more so than the stom- 
ach, heart, spleen, brain, or, in fact, any other organ of the 
hody. 

The poison (malaria) that causes remittent fever, affects 
the blood, and, as a matter of course, every organ in the 
body suffers. 

If the temperature reaches 105°, the case must be treated 
energetically, and with children convulsions will often oc- 



36 



MALARIAL FE:VKRS. 



cur, unless under the influence of some remedy to prevent 
them. 

When in any doubt as to whether the fever is t3^phoid or 
malarial, I usualiy test the same by using quinine freel}^ 
If m^alarial, the fever will subside when the patient is fully 
under the influence of the same ; but if typhoid, the S3"mp- 
toms will all remain and no harm result, only the disagree 
able symptom of cinchonism, which will soon pass awa}^ if 
the quinine is withheld. However, if the quinine should 
be given in large doses (13 to 30 grains), there will be some 
reduction of the temperature, but only for a short time. 

In remittent fever there may be two remissions in twenty- 
four (24) hours, and again it may be forty-eight (48) hours 
without any. 

In some cases this is owing to the treatment that the pa- 
tient has received. 

After the remissions occur a few times, if the patient takes, 
no anti-malarial medicine, the remissions may cease to oc- 
cur, and then the fever becomes continuous, assuming often 
a low form, simulating typhoid ; yet it is not a true t3'phoid'' 
but simply a low form of malarial fever. 

RECAPITULATION. 

The following is a very good description of the symp- 
toms of remittent fever, and cover what I have written 
above so well that I quote : 

"There are generally premonitory signs, but the attack 
may be sudden. 



MALARIAL FEVERS. 



37 



"Gastric irritation is usually first noted, there being a 
sense of uneasiness or oppression at the epegastrium, nausea, 
and anorexia, with headache, general pains and a feeling of 
languor. 

' 'Some chilliness or rigors may be experienced, but there 
is no cold stage of any duration, and the temperature rises 
immediately. 

"The hot stage becomes very intense, the skin burning 
and dry; the face flushed, the eyes injected, with intense 
headache, giddiness, restlessness, sleeplessness, and often 
delirium, which is sometimes violent. Vomiting and nausea 
are commonly present, the vomited matters consisting first 
of food, then of a watery fluid, and finally of biliary mat- 
ters ; they may become black or brown. 

"A sense of great oppression and weight is felt in the 
epigastrium ; the tongue is furred and tends to dryness, the 
lips are parched and there is intense thirst, 

"The pulse is frequent, and either full or small and com- 
pressible. The symptoms abate generally in from six to 
twelve hours, but may continue for twenty-four, thirty-six, 
or forty-eight hours, or longer. 

' 'Some perspiration usually breaks out as improvement 
takes place. 

"The remission is of variable duration, and this is fol- 
lowed by an exacerbation which is of greater intensity than 
the first paroxysm." — (Encyclopedia of Medicine and Sur- 
ger>\) 



38 



MAIvARIAI, FEVKRS. 



TREATMENT OF RKMITTKNT FFVKR. 

Being satisfied that the case is one of remittent fever^ 
then the treatment is easy. 

Quinine is the sine qua non — the remedy of all remedies, 
in the treatment of this disease. 

If there is such a thing (?) in medicine as a specific, then 
quinine is for malarial fevers in all their forms. 

There is no need of preparatory treatment (getting the 
system right for the quinine), nor is there any need of wait- 
ing for a remission; give the quinine at once ! in doses of five 
(5) grs. (for an adult) every two hours, is the dose I usually 
employ. 

Give the quinine in a capsule, and it will be retained, on 
the stomach, better. 

If there is much nausea and vomiting, a small portion of 
morphine will often quiet the stomach. Mint water or one 
drop of creosote (well diluted) with bismuth will settle the 
stomach. 

Morphine in my hands has aiwa3^s acted well when all 
other remedies failed. 

If the bowels are constipated, give epsoni salts in broken 
doses; one teaspoonful of salts dissolved in a small quantity 
of water, repeating this dose every two (2) or three (3) 
hours until the bowels act well. 

Give bromide potassa, in doses of from fifteen to twenty 
grains, to relieve the pain in the head and back. In fact, I 
sometimes think bromide potassa has .some specific effect on 



MAI.ARIAI, FEVERS. 



39 



malarial poison, — at any rate it is a good remedy to use with 
the quinine. 

Continue the quinine and bromide potassa every two (2) 
hours until the skin becomes moist, the pulse soft, and the 
thermometer shows the remission of the fever has occurred ; 
then, if the patient is fully under the influence of quinine, 
make the intervals longer — every four or five hours instead of 
two. 

When the patient is thoroughly cinchonised, roaring in the 
ear and some deafness will be the result. Most people in 
this country are familiar with the use of quinine, and know 
when a patient is under its influence. 

The danger in treating remittent fever is in not giving 
enough quinine, and very few are likely to give too much. 

Cloths wet in cold water and applied to the head, are 
grateful ; or pouring cold water over the head ; cold drinks 
of water or lemonade may be given to gratify thirst, but not 
too profusely, as large draughts will often cause vomiting. 

If the quinine can not be retained on the stomach, then 
double the dose and inject in the bowels. The best plan of 
using quinine by the bowels, is to fi}st give the patient a 
large injection of warm water and soap, thus washing out 
the lower bowel well, then give the quinine in as small a 
quantity of water as possible, after the large injection of 
warm water and soap has passed ; then the patient will be 
more likely to retain the quinine injection, and the same 
will be absorbed by the bowels more readily. 



40 



MALARIAL FEVERS. 



The injection of quinine should be repeated every three 
or four hours. 

The best plan to prepare the quinine for injection is to 
dissolve the same in a few drops of elixir of vitriol and then 
add a small quantity of water, as quinine don't dissolve well 
in water alone. One drop of the vitriol to each grain of 
quinine will make a clean solution and pass through the 
syringe more readily. 

The plan of rubbing quinine on the skin, is of not much 
sen'ice, — the skin is throwing off in fevers, — and it is very 
questionable as to the amount that is absorbed in any case. 

How^ever, in children, when it cannot be retained by the 
stomach or rectum, the practice of rubbing on the surface 
should be resorted to — one teaspoonful of quinine mixed 
with one half teaspoonful of lard, and this spread over the 
chest and under the arms, or the quinine can be dissolved in 
whiskey and applied in like manner. 

Time, precious time, must not be lost in these cases. Get 
the patient under the influence of quinine as quick as pos- 
sible. 

Children with remittent fever often have convulsions when 
the fever is high, and I respectfully refer to the chapter on 
convulsions for the appropriate treatment. 

Chloral hydrate and bromide potassa, of each about fif- 
teen grains, diluted, will relieve the pain in the head ani 
back so much complained of in remittent fever. It is also 
the dose to give when the patient is delirious and restless. 
Bromidia is also an excellent remedy in such cases, as it 



MALARIAL FEVERS. 



41 



contains chloral hydrate, bromida potassa, Indian hemp and 
hyosciamus, a good combination, and one that generally 
acts well. Dose, one teaspoonful (for an adult), well diluted. 
If the patient has an irritable stomach, the chloral hydrate 
and bromide potassa will be more likely to be retained than 
bromidia. 

If symptoms of congestion occur, increase the dose of 
quinine, using brandy or whisky also. 

Emetics and mercurial cathartics are not necessary. 
Under the head of general treatment this subject is dis- 
cussed at some length. 

After the patient has had fever for some days and seems 
prostrated, then supporting remedies will be necessary ; a 
moderate amount of brandy or whisky, and a good diet of 
soup, etc., etc. 

It will be necessar\' to use the same precaution in treat- 
ing women in family-way (pregnant) with remittent fever, 
as described in the note in intermittent fever. 

Warberg's tincture is an excellent remedy in remittent 
fever, and much used by the profession. It contains a large 
amount of quinine and cinchonidia, rather costly ; but I 
have thought best to recommend quinine alone, as the 
people generall}- know the dose and are familiar with its 
use. 

RECAPITULATION. 

T. — Keep in view the fact that the patient's system must 
be saturated with quinine, and that as soon as possible. 
If the stomach will not tolerate it, give it by the rectum, 



« 



42 



IvIALARIAL FEVERS. 



and if not retained, apply to the surface of the body. 

2. — If nausea and vomiting, check by creosote and bis- 
muth, mint water, or small doses of morphine, also apply 
mustard to stomach. 

3. — Open the bowels (if constipated) with salts ; small 
doses, repeated every three or four hours : at the same time 
using large injections of warm water and soap in rectum. 

4. — Apply cold water ; not ice water^ to head, using small 
quantity* of ice water or lemonade to gratify the thirst. 

5. — For severe pain in head and bones and convulsions in 
children use chloral hydrate and bromide potassa. or 
bromidia. 

6. — When the patient is convalescing use a tonic. 



HEMORRHAGIC MALARIAL FEVER. 

SVMPTOMS AND COURSE. 

Name. — Hemorrhagic Malarial Fevers. Intermittent 
Haematuria, Black Jaundice, Malarial Haematuria. (In 
Texas, this fever is known as Black Jaundice.) 

Definition. — "This affection is characterized by the oc- 
casional, and generally periodic, discharge of albuminous 
urine, more or less deeply tinged with the coloring matter 
of the blood, and frequently containing blood, and casts of 
the uriniferous tubules. It occurs most frequently in mala- 
rious regions, and in individuals who have suffered repeated 
attacks of malarial fevers; and the di.scharge of bloody urine 



MAI^ARIAL FEVERS. 



45 



is often, but not always, attended with symptoms which 
characterize an attack of ague, and with jaundice." — 
(Sternberg.) 

This is one of the graver forms of malarial fever, and the 
mortality is great. 

My experience is, that this form of (hemorrhagic mala- 
rial) fever, always occurs in one whose system is broken 
down from repeated attacks of malarial fevers, (either ague 
or bilious). 

The symptoms are the same as in either ague or remit- 
tent fever, except that the urine is bloody, and in some in- 
stances blood passes from the bowels, and is vomited. That 
from the stomach is usually dark, resembling coffee grounds 
in appearance. The skin becomes jaundiced, and later on 
appears blue, and from this symptom many in this countr}^ 
call the fever the " black jaundice." 

There is generally no difficulty in forming an opinion as 
to the disease. 

The attacks are periodical, as in ague; or there is a remis- 
sion, as in bilious fevers. The skin is first yellow, after- 
wards dark (or blue). As said above, this symptom ac- 
counts for the name given to this disease by some. 

I object to this name, for the reason that the jaundice is 
only one of the symptoms, and carries no true idea as to the 
nature (pathology) of the disease. Hemorrhagic malarial 
fever, or malarial fever with hemorrhages, describes the 
disease more fully. 

These cases are always serious, and the patient should 



44 



MALARIAL FEVERS. 



have the counsel of a physician, if possible, without delay. 

The urine varies in color, from a smokey hue to pur^ 
arterial (red) blood. "The bloody urine may appear during 
a paroxysm of intermittent fever, which has been preceded 
by one or more paroxysms unaccompanied by this symp- 
tom; or it may appear suddenly in one who has been sub- 
ject to malarial attacks, but who has not experienced one 
for some time. In this case, it is commonly produced by 
exposure to damp and cold. After such exposure, the 
patient gets up in the morning feeling languid, and indis- 
posed to take food or to exert himself. Later on, he may 
have slight chilly sensations, or a distinct chill, followed by 
more or less fever, then he discovers his urine, which was 
perfectly clear when he first arose, has suddenly assumed a 
hright or dark red color, or it ma}" be the color of porter. 
Upon standing, it deposits a copious reddish brown sed- 
iment. 

Two or three discharges of this character may take place, 
and then the urine suddenly, or gradually assume its normal 
appearance. 

The discharges of bloody urine are sometimes preceded 
by a sense of fullness, or of pain, in the region of the kid- 
neys; and this, with a feeling of weariness, may be the only 
.symptom attending the attack, other than the hemorrhage. 

The periodic character is manifested by a recurrence of 
the attack every day, or every second or third day, at the 
same hour. The paroxysms 7nay OQcnr at longer intervals, 



MALARIAL FEVERS. 



45 



and without any very decided regularity as to the date of 
recurrence. 

In some cases, the symptoms of hemorrhagic malarial fever 
resemble yellow fever, and the fever is called b}' some 
Malaiioits Yellow Fever, a name liable to mistake. 

Yellow fever is a disease of one paroxysm, and intensely 
contagious, while malarial hemorrhagic fever has an inter- 
mission, or remission, in the fever, and is not contagious. 

There can be no doubt as to malaria being the prime 
cause of this form of fever: all authorities, I think, agree o^ 
this point. 

The people, in this country-, have a great dread of this 
disease, and regard the same as almost alwa3^s fatal; 3-et I 
am satisfied, if the facts were known, most of the cases re- 
cover. 

I know this is tme in the practice of the ph^'sicians in 
this part of the South, who seldom lose a case, unless it is 
one in which the disease has been allowed to run its course 
for some time, without treatment, or in a patient whose 
sj^stem has been badly wrecked (broken down) by repeated 
attacks of malaria, and who lives in an intenseh' malarial 
region. 

A writer in Dr. Jones' Memoirs, saj^s : "I find that ever\' 
patient I have had or seen (with hemorrhagic fever) has 
had previous attacks of chills and fever, and in consequence 
the spleen is ver}' much enlarged. So invariably is this the 
case, that when my friends enquire of me how to avoid this 
disease, I tell them to break up their chills promptly, and 



46 



MALARIAL FE:VERS. 



not to let their blood be poisoned by the long continuance 
of them." This is from the pen of a physician in lyouisiana, 
and is good advice. 

Another Louisiana physician says, (speaking of hem- 
orrhagic malarial fever,) ' ' I have never seen a case of serious 
or grave import, but in connection with indubitable proof 
of chronic and intense malarial toxaemia" * * This con- 
firms what was said in the first part of this book, z. <?. , "to 
break the chills at once." Every attack racks the system 
to some extent. 

Many observers contend that the urine is not bloody, but 
stained with the coloring matter of the blood. On this 
point, the evidence is ver>^ conflicting; but be . that as it 
may, surely the passages from the rectum, and in some rare 
instances from the stomach, is pure blood. Professor Tyson 
says, "In this form of disease especially, it often happens 
that the coloring matter only, and the debris of blood disks, 
are found in the urine, very few, and often no entire ones 

being discernible" . Ferand asserts that the presence 

of blood in the urine is exceptional, and that the nidanuria 
(black urine) is due to bile pigments. He says, "The very 
remarkable color of the urine in nulamisic bilious fever has 
caused the vulgar to believe, and for a long time the doctors 
also, that the liquid contains a large proportion of blood; 
and I confess that for my part, I have been very much 
struck with it. At first view, it seemed very difficult to be- 
lieve that the color which I had ])efore my eyes was not due 
to blood, and even to very pure blooil, but my opinion has 



MALARIAI. FKVKRS. 



47 



been mbdified * I examined more than twenty 

different specimens of melanuric urine, by means of the 
microscope, without ever discovering a single blood globule, 
* Not wishing to trust to my personal examina- 
tions, I have had numerous examinations made by medical 
officers under my orders, several of whom had ample ex- 
perience in the use of the microscope, but no one among 
them was more successful than myself ' ' 

Dr. Joseph Jones, of New Orleans, finds blood in the 
urine in these cases. 

Dr. Sternberg sa3^s, "While we must admit that the 
presence of blood has been established in numerous cases, 
yet it is beyond question that bile-pigments are also present 
in large quantities, and perhaps more uniform than blood. 
The disease is essentially a bilious fever, and aside from the 
presence of blood in the urine, has no decided hemorrhagic 
tendency." 

TREATMENT OF HEMORRHAGIC MAI.ARIAL FEVER. 

In no form of malarial diseases are the profession so di- 
vided in their treatment, as in this. 

While the large majority agree that quinine should be 
administered, others argue stoutly against its use, claiming 
that quinine aggravates the kidneys and increases the flow 
of blood. 

My own experience is decidedly in favor of its use. 

Dr. Druett says, (in writing of the treatment of this form 
of malarial disease), "Of medicine deserving the name there 
is but one, and that is quinine in full doses." 



48 



MAI.ARIAI, FKVKRS. 



Prof. Tyson says : ' 'The treatment is distinctly that of 
malarial disease, and I have seldom seen more brilliant and 
satisfactory results than have followed the use of quinine, in 
a case accurately determined, although such results are not 
invariable, and I have known the disease to resist for a long 
time the most thorough and judicious use of anti-malarial 
remedies." 

Quite a variety of remedies have been used to check the 
flow of the bloody urine, such as vegetable acids, sulphate 
iron, sugar of lead, catechu, chlorate potassa, etc., etc. The 
benefit derived from any of them has been questionable. 

I would recommend in every case (until a physician can 
be consulted) that the bowels be opened with an injection 
of warm water and soap, and quinine be used freely ; dose, 
five to ten grs., (for an adult,) every two or three hours 
with bromide potassa to quiet nervousness. 

Warburg's Tincture is the best remedy that can be used, 
in this form of malarial disease. It has been much used of 
late, and is regarded by all as one of the very best. For- 
merly it was a patent remedy, but its formula is now known 
to the profession. 

The formula is printed on the bottle, with the directions, 
and I can safely recommend it, in these cases. The dose for an 
adult is one teaspoonful, diluted.- Repeat every two hours,, 
until the patient is fully under the influence of same, Dr. 
McLean says, "It acts as a powerful diaphoretic, the most 
powerful with which I am acquainted." In this way, it may 
relieve the kidneys of extra work (by acting on the skin 



MALARIAI, FKVKRS. 



49 



freely), as well as by destroying the malaria in the system. 

My plan of treating hemorrhagic malarial fever, is the 
same as the graver forms of ague and remittent fevers, ex- 
cept ftiat opiates, in all forms, should be avoided (if pos- 
sible). 

This form of malarial fever seldom occurs, except in sub- 
jects whose systems are broken down by repeated attacks of 
malarial fevers; consequently the system should be toned 
up. After the paroxj^sm is over, the patient should by all 
means be moved out of the malarious atm^osphere. 

It is astonishing that a sensible person will live in a place 
knowm to be intensely malarious, and be subject to repeat- 
ed attacks of hemorrhagic malarial fever, when perhaps a 
few miles travel would remove him from the malaria. 

I can speak from experience, that the case subject to such 
attacks, and continuing to reside in such malarious localit}^ 
will soon succumb to the disease. 

We cannot remove the cause, because it is atmospheric, 
but we can certainly move the patient. 

Remove him (after the paroxj^sm has passed,) from the 
malarious place, give him quinine and iron, with a good, 
generous diet, and he will soon regain his health. 

In speaking of these cases, I often use the following 
homely illustration: Suppose a man is bitten by a snake. 
We administer antidotes, and relieve him. He recovers, 
but is considerably debilitated. Immediately he lets the 
snake bite him again. How long can his system stand 
these repeated injections of poison? Just so with malaria. 



-50 



MAI.ARIAL FKVKRS. 



We administer remedies to neutralize the poison (malaria) in 
the S3'Stem, but the patient immediately is exposed, and 
again takes in the poison (by sta^dng in the malarious 
region) , consequently it is only a question of time as to how 
long his S3^stem will bear these repeated attacks. 

I have no experience wdth turpentine in these cases; 
While free action from the kidnej^s is desirable, it is per- 
haps best to obtain that result by using w^ater freely. 

A writer. Dr. Thompson (ex-Cenfederate Surgeon), and 
whose field of practice is in the malarious regions of White 
River, Arkansas, says, "Cure the malarial malady, and 
you can cure the hsematuria" (bloody urine). He regards 
^ 'quinine as the sheet anchor in the treatment. ' ' 

There is a great diversity of opinions among authorities, 
as to the treatment of this grave form of malarial sickness ^ 
My own experience is in favor of the quinine treatment. It 
is well to state, in some of the graver forms, no remedy 
seems to avail, and the patient dies. 

Some physicians give a mercurial (calomel) purge (lo to 
1 5 grains) first, and then follow with quinine. 

If calomel is admissible in any form of malarial disease, 
it is in this, from the fact that radical changes have 
taken place in some of the organs, and the kidneys are 
certainly irritated, if not inflamed. Calomel will sometimes 
quiet the stomach, check vomiting, and unload the liver 
and bowels. 

I do not think there can be any question but that calomel, 
when administered, passes out of the system by the kidneys, 



MALARIAL FEVERS. 



51 



as well as by the bowels, and may do good in this manner; 
3'et I think the same results can often be accomplished b}' 
less irritating and debilitating remedies, rhubarb, salts or 
oil, or the remed}- so much in use in this countrs', Simmon's 
Liver Regulator. I am averse to recommending a patent 
nostrum, but this one is so universally used, that nearl}' 
every family in this countr}' keeps a suppl}' on hand. 

In detailing my experience with malarial hemorrhagic fever, 
I must confess that the countn,^ that I have practiced in is 
not so intensel}' malarious as some parts of this State, 
Louisiana and Mississippi, and perhaps it has been the 
milder forms that I have had to contend with. ^lan}^ of 
these physicians are positively opposed to the use of quinine 
in this form of malarial disease, some using none, others 
waiting until the parox3'sm subsides and the urine becomes 
clear, then administering quinine. 

A few writers believe that quinine will cause the urine to 
become bloody again. Below are a few extracts from some 
who hold these views: Says a Louisiana physician, "I 
persistently used quinine for a long time, and lost my cases. 
Now that I have rejected it altogether, the mortality is 
much less." 

It will be unnecessary for me to quote at length from men 
who hold such views, as this book is supposed to reflect my 
own, and I must say still, that my confidence is in quinine. 

It is the great anti-periodic remedy. After exji mining all 
the latest authorities on this subject, the preponderance of 
Evidence is in its favor. 



52 



MALARIAI, FEVERS. 



Saline cathartics, with wami water and soap injections; 
mustard to stomach and chest, Warburg's tincture or qui- 
nine, and bromide potassa to quiet nerv^ousness. 

Dr. Webb, of Alabama, who seems to have had much ex- 
perience with this form of fever, says: 

" Quinine will undoubtedly, in a certain number of these 
cases, increase the hematuria (bloody urine), and some- 
times even seem to cause it. Seeing t£is, the timid admin- 
istrator stops his quinine, and his patient dies, with quinine 
under the ban of killing him; whereas, with a bolder hand, 
directed by a proper idea of the true cause of this S5miptom 
(a disturbance of the vaso-motor system under malarial in- 
fluences), he would have unhesitatingly continued it, and 
his patient might have had a good chance to live. Remove 
the cause of the disease, and the haematuria (blood}' urine) 
will cease. I have seen quite a number of cases to which 
this remark applies, some in which the quinine, given at the 
expiration of the second hebdominal period, as a proph3dac- 
tic measure, (a measure familiar to all physicians in mala- 
rial regions,) caused a return of a decided haematuria, with- 
out fever. In these cases, I have not hesitated to repeat 
the quinine next day, with the best results. 

Again I advise that a physician be called to these cases, 
at once, as this is one of the grave forms of malarial disease, 
and requires much skill to treat. By all means, (as scon as 
possible,) remove the patient out of the malarious atmos- 
phere. 



MALARIAL FEVERS. 



53 



GENERAL REMARKS ON THE TREATMENT OF 
MALARIAL FEVER. 

Having discussed the various types of fever, their cause 
and treatment, I propose, under this head, to discuss at some 
length, the treatment recommended, quoting from authori- 
ties to sustain the theor}' set forth in this work. 

There is no such thing known in medicine as an hifoAlible 
remedy, specifics — here is the disease and there the remedy. 

Nature is the great worker. It is the natural working of 
the system that effects the cure in any case, and all we can 
do with medicine is to assist nature in its work. This is a 
fact that is too often lost sight of, and many times physi- 
cians give more than is necessar3\ Most of the remedies 
used as a medicine are fojeign to the system. 

In a work of this kind I cannot enter into details and ex- 
plain how the various medicines are supposed to act in the 
system, nor do I think it essential ; suffice it to say that the 
"great majority of medicines must obtain entr}- into the 
blood, or internal fluids of the body, before their action 
can be manifested. ' ' 

I have explained the symptons, course and treatment of 
malarial fevers, in as condensed a manner as possible, and 
tried to impress the fact that malaria is undoubtedly a poison, 
that enters the system, causing periodic fevers, and that ex- 



54 



MALARIAL FEVERS. 



perience demonstrated the fact that qicinine is the remed}^ of 
all remedies, — the grand old medicine that has safel}- car- 
ried us through many tr3dng cases of malarial sickness. 

Quinine, when earl}^ and freel}^ used, — before an}' changes 
are produced in any of the vital organs b}^ repeated attacks^' 
will stop or cut short an}^ attack of malarial fever. 

Let me emphasise the fact that the sj'stem needs no pre- 
paration ; the preparatory- treatment generally used is worse 
than useless. It hurts the sy-stem and consequentl)' does 
harm. Calomel, the remed}' usually administered, was 
given \^ears ago, under the impression that all fevers were 
infiammator}^, and like all ideas that obtain a hold on the 
minds of the people, it is hard to eradicate ; although it has 
been proven (often) to be <?; ; oneoiis, for calomel is positivelyr 
hurtful in malarial fevers. 

For ten years I have abandoned its use in the treatment 
of malarial fevers, and have found no cause to regret it. 

Often phy^sicians speak of its action on the liver and claim 
to administer it for its effect on that organ. It is ver}^ ques- 
tionable whether it has any effect on the liver. The dark 
and offensive discharges that follow its administration are 
said to be due to a decomposition of mercuiy in the sy-stem. 
The discharges have been examined time and time again and 
no bile found, but the color shown to be due to the mercury. 
The same actions will follow if calomel is administered to a 
man in perfect health. 

Doctors (I fear) are like other people, that is — it is the 



MALARIAI, FEVERS. 



55 



fashion (custom) to use certain remedies , and they use them 
without questioning the utility of their action. 

The old practice to commence with calomel and blue mass 
and then use quinine, has had its da}^, for m.ost intelligent 
people dread calomel, and are asking : Is there not some 
way to avoid its use ? / answer^ it is unnecessary. 

Sternberg (one of the very best authorities on malarial 
fevers) says : 

' ' Formerly the opinion prevailed that a certain course of 
preparatory treatment was necessar}^, in order that quinine 
might favorably influence the course of the fever. This 
idea no longer controls the practice of intelligent physicians 
in malarious regions." 

A distinguished teacher, Dr. Morehead, says : 
" The practice, at one time too common, of administer- 
ing calomel, in doses of four or five grains, three or four 
times in the course of the day, without any very definite 
object, and continuing it for a succession of days, cannot be 
too strongly condemned ; not only is it unnecessar}^, but for 
the following reasons positively injurious. : 

I. "In watching the progress of cases thus treated, it is 
not difficult to detect a train of symptoms fairly attributa- 
ble to the treatment (calomel) than the disease, because it is 
in cases thus tested that it has been chiefly obser\^ed. The 
symptoms alluded to are uneasy feelings, sometimes amount- 
ing to pain with a sense of oppression or "sinking" at the 
epigastrium (stomach), and occasionally griping of the ab- 



56 



MALARIAL FEVERS. 



domen, for which leeches are not unfrequeiitly applied and 
purgatives given. 

2. "The frequent repetition of the calomel 'keeps up a 
furred state of the tongue,' with 'nausea' and 'irritabili- 
ty' of stomach, aggravates the febrile excitement and pro- 
duces an irritable state of the bowels, indicated b}- frequent 
water}' discharges. 

3. "The convalescence of cases thus treated is alwa3'S 
'tedious,' and frequently complicated with diarrhoea and 
cla3'-colored discharges. 

"Not onh' is the practice unsound in theory and of no 
value, but is contrar\- to rational theory and very injurious. 
If it be true that prostration of the vital actions and a dete- 
riorated state of the blood are vers* unfavorable conditions 
in remittent fever, and that mercur}' deteriorates the blood 
and favors prostration, on what principle of reasoning can 
it be maintained that mercurial influences induced by the 
physician can have any other than an 'injurious effect in 
remittent fevers. ' 

' ' I have on several occasions pointed out the tendency of 
malarious fevers to produce a cachectic (broken down) state 
of the system, and have endavored to inculcate the impor- 
tance of guarding against the increase of this unfavorable 
diathesis of medical treatment. To all who within the past 
twent}' years have had an opportunity of extensively ob_ 
ser\'ing disease in India in the various classes of European 
^^ociety, — asthenia, dyspepsia, injured teeth, pains in side 
and loins, palpitation, habitually 'foul tongue,' constipated 



MALARIAL FEVERS. 



57 



bowels, pale alvine evacuations, depressed spirits and a sense 
of sinking at the epigastrium (stomach), all traceable to 
the abuse of mercury — must be familiar facts. 

"Such, then, are the reasons drawn from my own sphere 
of observations, which have led me to the conclusion that 
the induction of mercurial influence in the treatmxcnt of 
malarial fevers has been a 'great and grievous error' in 
therapeutics. ' ' 

I heartil}' endorse every word said by this distinguished 
phj^sician, and can verify the facts b}^ daily observation. 

Dr. J, Fors3^the Meigs says (in speaking of the use of 
mercurv^ in malarial sickness) ; 

' ' To say the least they (forms of mercury-) are unneces- 
sary, and any one v\'ho has seen the gastric distress, intes- 
tinal irritation, or the constitutional poisoning, which mer- 
cury not unfrequently induces, will be glad to know that 
he ma}', with a good conscience, dispense with its use in 
so severe and dangerous a disease as this of malarial fever 
often is." 

Dr. Austin Flint, (one of the ablest physicians America 
has ever produced,) in his work on the practice, speaking 
of malarial fevers, says : 

"There is no need of preparatory treatment. This posi- 
tion was taken b}' the author in an article published more 
than thirty years ago. An experience embracing many 
hundred cases, in different climates, since the date of that 
publication, has abundantly confirmed the correctness of 
this position." 



58 



MAI.ARIAL FEVKRS. 



Again he says : ' ' The pathological views (nature of the 
disease) which formerly led practitioners to employ mercury 
freely in this disease, are not tenable, and it ma}^ fairly be 
doubted if clinical observation affords any ground for regard- 
ing this remedy specially indicated." 

Again he says : ' ' Time need not in any case be lost in 
order to resort to cathartics or other measures preparatory 
to the exhibition of an anti-periodic (quinine) remed3\" 

Headland, in his work on the action of medicine sa3'S : 

' ' Mercury disintegrates or decomposes the blood and thus, 
wastes the body. ' ' ' 'This is the systematic action of mer- 
curv% on which too much stress cannot possiblj^ be laid." 
"It is an agent of terrible activity, and we ma}' well be 
cautious how we handle it. " ' 'When the skin cannot carry 
off the poison (mercury) in sufficient quantity — when the. 
solvent powers of the urine is exhausted — when the bowels, 
are prevented by opium from eliminating the mercur}', then,, 
as a last recourse, the salivar}^ glands step in and in the sal- 
iva the metal finds an exit, (salivation)." 

QUININE. 

There can be no question but this is the remed}- of all 
remedies in the treatment of all malarial fevers. It has 
stood the test for years and its use is no longer an experi- 
ment. It is the battle axe with which to do effective work 
in treating malaria in all its forms. 

Dr. Flint says: "It is a specific, if any remedy is entitled 
to this appellation." 



MAI^ARIAI. FKVKRS. 



59> 



So much confidence have I in the remedy that when 
called to a patient in the first attack, I' feel confident that 
he will not have another, if he takes the remedy freely. 

How it acts on the poison in the system no one, so far, 
has been able to demonstrate, but that it will cut short the 
disease, there can be no question. 

Really, malarial troubles are not, properly speaking, dis- 
eases, until after the poison has effected some change in the 
system. At first it is a poison that racks the whole bod}^ — 
every organ suffers, and the patien is in pain from head to 
feet ; but, usually, as he is under the influence of quinine, 
all these symptoms vanish. The patient is some w^eaker, 
but in a short time will regain his health. But let the par- 
oxysm return and continue — soon the constitution becomes 
surcharged with malaria, the spleen and liver enlarged, the- 
blood weakened, and in addition to all this calomel in the 
bones ; and what a picture ! 

People are slow to change preconceived opinions, and all 
reforms are gradual; but when reaction does come, it sweeps 
clean. 

Sooner or later mercury will be banished from the list of 
remedies in malarial diseases. There is danger however, in 
extremes going too far, for mercury is a good remedy in 
certain cases, especially in inflammatory diseases, indeed, 
one of the best in pneumonia, acute rheumatism, etc., etc. 
When the patient is stout, and we wish to lower the vital 
powers, it is one of the best substitutes for blood letting. I 
mention this fact here, to show I have no prejudice against 



MAI.ARIAI. FEVERS. 



the proper use of calomel. It is a remedy of force and 
power, and a good one when judiciously used; but I hold 
there is no necessity for it in the treatment of malarial 
fevers. 

Bleeding is an old remedy, and a good one in some cases 
of pneumonia, or in fact any acute inflammations; but med- 
icine has its fashion, and bleeding is now "one of the lost 
arts." It was formerly the custom to bleed in malaria] 
fevers, but that practice has long since ceased. 

Professor McIyCan says, "I have been led to take a view 
of malarial fevers generally, and remittent fevers in particu- 
lar, different from that laid down by many authors. 

"It appears to me that the so-called anti-phlogistic [calo- 
mel] treatment, so much insisted on b}^ many writers, is 
based on the belief that the phenomena observed in a case 
of remittent fever are consequent on a process of inflamma- 
tion. It is onl}^ on such a belief that anti-phlogistic treat- 
ment can be justified." 

During the exacerbation of a remittent fever there is vio- 
lent disturbance both of the vascular and nervous system. 
Almost every organ, almost every function suffers. The gas" 
trie intestinal membrane is affected, the liver and spleen suffer, 
the brain is involved, for rending headache and delirium 
are often present. Is it rational to suppose that an inflam- 
matory process can be going on, at one and the same time, 
in all these various organs? Do the appearances observed 
post mortem (after death) give any support to such a doc- 
trine? 



MAIvARIAL FKVERS. 



6i 



If not, on what principle can spoliative treatment be justi- 
fied? Is it not rather the case that this terrible disturbance 
of so many organs is due to the presence in the blood of a 
subtle poison acting on them all? If so, surely the guiding 
principle of the physician in his treatment should be to 
counteract this poison, to neutralize it, or to expel it from the 
system, and so prevent a recurrence of the exacerbations. 

This is the principle on which I have long acted, and I 
am satisfied that it is at once a safe and successful one. In 
quinine we have such an antidote, a therapeutic agent of 
unrivaled efficacy, which, if skillfully used, will rarely dis- 
appoint the practitioner. 

It is always, of course, advisable to have the bowels 
thoroughly evacuated, and if the patient is seen when the 
stomach is loaded (soon after a meal), it will be necessary 
to evacuate its contents by an emetic. In ardent remittents, 
however, there is generally little call for this, as obstinate 
vomiting is almost always a troublesome symptom. 

This done, the period of remission must be watched for, 
and the moment it arrives quinine in a full dose should be 
given — not less than fifteen grains in the case of an adult. 

If the irritability of the stomach be so urgent that the 
remedy is rejected, means must be adopted to allay it. 
Time, precious time, should not be lost. Quinine should 
be given by the rectum, in a full and efficient dose. 

By mouth or by rectum, or by both, quinine in quantities 
sufficient to induce some of the symptoms of saturation (cin- 



62 



MALARIAL FEVERS. 



chonism) should be given before the time of expected ex- 
acerbation. 

In closing these general remarks, I feel that if this book 
should cause a general inquir}' in reference to the abuse of 
calomel in the treatment of malarial fevers, and a revolu- 
tion in the treatment, as now generally adopted through 
this country, it will save the people much unnecessar}- suf- 
fering, and I will be repaid for my trouble in bringing the 
matter to their attention. 



COXVULSIOXS. 



SYMPTOMS AND COL'RSE. 

Children have spasms from a variety of causes, but I 
shall only describe the symptoms, course and treatment of 
convulsions occurring during an attack of either intermit- 
tent or remittent fever. 

Some children, with large brains and a highly developed 
nen'ous sj'stem. will have spasms from very slight fever 
(102 }4), as it takes only a moderate amount of fever to 
make them ver>' nen'ous and much excited. 

Fever affects no two alike. While some children are 
drowsy, and will sleep during an attack of fever, others are 
wild, and often delirious. 

By watching a case of fever, in a child, closely, an attack 
of spasm can usually be foretold. 



MALARIAL FEVERS. 



63 



Just before the spasm, the little patient usually becomes 
ven- ner^-ous and highh" excited; the least noise arousing 
from sleep, the child seems easilj' frightened, excited, 
scared, trembling, afraid something will happen to it, cling- 
ing close to the mother or nurse. 

These symptoms, when the fever is high, should alwa^'s 
be taken as a warning that the child will have a convulsion 
soon, if no remedy be given to prevent. 

Sometimes, however, there is no warning symptom, the 
spasm coming on suddenly. 

When the convulsion comes on, the child will usually 
cry out, and ever}' muscle become contracted, the head 
drawn back, the e^-eballs roll to one side, and seem fixed 
(staring), the jaws either locked or working rapidly, often 
biting the tongue, unless some substance Tcork is best) is 
placed between the teeth to prevent. Consciousness is lost, 
the arms and legs drawn and violently jerking, the toes and 
fingers contracted, the angles of the mouth drawn to one 
side, the teeth grate, upon the lips often appears a white 
froth or foam. 

The whole body is twitching by the spasmodic contrac- 
tions of the muscles, and often, in severe cases, the back of 
head and feet are the onl}- parts of the body that touch the 
bed. 

This state of afiairs (spasm) may only last a few minutes, 
or it may continue for hours, and the child die in the con- 
vulsion. 

Usually, in a few minutes the paroxysm begins to sub- 



64 



MAI^ARIAI, FEVERS. 



side, the patient takes a deep inspiration and becomes 
quiet, and if not disturbed will fall into a sleep; but the 
fingers and toes are not relaxed. In such cases, usually 
the attack will soon return, with all the force and violence 
of the first. 

The bowels and bladder are often evacuated uncon- 
sciously. 

Convulsions occurring during fever, should alwaj^s be re- 
garded as serious; for while a large majority recover, 3^et 
every case should be treated energetically and promptly, 
and an effort made to prevent a return of the paroxysm. 

It is easier to prevent a convulsion than to check one? 
consequently the warning should be closely watched for, 
i. e., twitching of muscles, restlessness, excitement or roll- 
ing the eyeballs, etc., etc. 

During the convulsive attack blood may be extravesated 
on the brain, and after the patient recovers from the fever 
and convulsion, paralysis result from this pressure. 

I saw a case a short time since, (little girl of eight years,) 
who was unable to speak (talk) for three weeks after the re- 
covery from the fever, because of blood pressing on the 
brain, producing paralysis of tongue. (She had convul- 
sions during the attack of fever.) At first her articulation 
was poor, but soon recovered. 

In another case, after a violent convulsion, the child lost 
all consciousness, and for three weeks lay in a stupid condi- 
tion, ate and drank mechanically, just as food was given 



MALARIAL FEVERS. 



65 



lier. She finally recovered, but partially paralyzed in one 
half her body. 

Children do not always lose consciousness when they 
have a spasm, for although the body is jerking and muscles 
contracted, they seem to be aware of their condition, and 
will try to take any water, food or medicine given them 
during an attack. 

There certainly can be no mistake as to a convulsion, the 
.symptoms are usually so plainly marked, as so fully de- 
scribed before. 

These convulsive attacks vary in intensity from slight 
jerking and twitching, with restlessness, without any loss 
of consciousness, to violent attacks, which toss the whole 
body about, drawing the face, fixing the eyes, contracting 
arms and legs,, often causing death during the first convul- 
sion. In fatal cases the respiration and circulation is em- 
barrassed, and death takes" place as a result of cerebral 
(brain) congestion. When the violent convulsive action 
(in such cases) cease, the little patient lies quiet, but it is 
often the sleep of death. The feet and legs become cold, 
and there is no return of consciousness — the whole system 
seems to succumb to the violence of the attack. 

In other cases,, the child has one convulsion after another 
at intervals, during which the stupor is gradually becoming 
more and more profound, the little one becoming unable to 
swallow or be aroused, till finally there is total loss of con- 
sciousness and sensation. This is the most frequent mode 
<of death in convulsions. 



66 



MALARIAL FEVERS. 



Convulsions do not affect the whole body every time, but 
in some instances seem to be confined to one side of the 
bod}^, or one arm and side of face ; at other times the e5^es 
and face, or the lower extremeties; 3'et this is rare. Usually 
the whole body is convulsed, and much contracted; but in 
the commencement of the attack, only one side ma}^ seem 
to be involved. 

While I do not think there generallj^ will be an}' difficulty 
in diagnosing convulsions, ^^et I will insert the graphic de- 
scription of spasm by Dr. J. Lewis Sm^ith. In describing 
the sj-mptoms, he says : 

"Eclampsia (spasm) is general or partial. If general, the 
muscles of the face, eyes, eyelids, and all the limbs are in a 
state of rigid involuntar}' contraction, alternating with re- 
laxation. The features lose their natural expression, and 
are distorted; the mouth is drawn out of shape, often to one 
side, by the violent muscular action; the teeth are pressed 
together by tonic contraction of the muscles of jaws, and 
may be violently struck together, so as to lacerate the 
tongue, if it protrude, or are ground upon each other. Un- 
less the attack is of short duration, frothy saliva, perhaps 
tinged with blood from the injured tongue, collects between 
the lips. The eyelids are usually open, though sometimes 
'i^ '^-^ they are closed. In severe cases, the eyes 

are turned up, so that the pupils are lost under the upper 
eyelids, or the muscles of the eyes are involved in the spas- 
modic movements, so that the eyeballs are forcibly drawn 
from side to side. Occasionally strabismus [squinting] oc- 



MAI^ARIAL FEVERS. 



67 



curs. While the features are thus distorted, the head is 
forcibly retracted, or is turned to one side; the forearms are 
alternately pronated and supinated; the thumbs and fingers 
are convulsively flexed, so that the thumbs lie across the 
palms, and are covered by the fingers; the great toe is ad- 
ducted, the other toes flexed; and the toes, as well as legs, 
participate more or less in the spasmodic movements. 

"In general convulsions, consciousness is usually lost. 
The head is hot previous to, and during the attack, '-^ 
and the face flushed. ^ ^ -^'^ The 
sphincters are relaxed during the convulsive attack, so that 
in many cases the urine and stool are passed involuntarily. ' 

' ' P irtial eclampsia (spasm) is more common than the 
general form, and it occurs in the muscles of the face, in- 
cluding those of the eye, of the face, and of one or both up- 
per extremeties, or of the face and extremeties on one side. 
The spasmodic movements may be even limited to the 
muscles of the eyes, and they often occur onh' in these 
muscles and those of the face. Rarely, if ever, does 
eclampsia affect the legs, without affecting also the muscles 
of the arms and face. In partial convulsive attacks, sensa- 
tion and consciousness are in some not entirely lost, but in 
others they are not manifested if present. 

' ' The duration of an attack of eclampsia varies somewhat 
in different cases, from a few minutes to vSeveral hours. The 
average is not more than from five to fifteen minutes. It 
does not often continue longer than^ three or four hours in 
the severest cases. It is sometimes said to last a much 



68 



MALARIAL FKVKRS. 



longer time, even for days, but there are in these cases in- 
termissions. Violent attacks are usually short. 

When the convulsion ends favorabl}^ the spasmodic 
movements become less and less strong, and finally cease. 
The child then takes a deep inspiration, after which it lies 
quiet, and the respiration remains regular, or moderately 
accelerated. Some fully recover in a few minutes, if the 
eclampsia has been light and the fever not excessive." 

TREATMENT OF SPASMS. 

The old maxim ' ' An ounce of prevention is worth a 
pound of cure," is certainly applicable to convulsions of 
children, occurring during an attack of malarial fever. 

When there is any doubt whether the child is threatened 
with convulsions, it is the safest and best plan to give the 
little one the benefit of the doubt. Place (at once) the feet 
and legs in hot water and mustard (or put the child in a 
warm bath), appl}^ cold water (not ice water) to head, and 
give a full dose of bromide potassa or a dose of bromidia. 

If the child is very restless, much excited and nervous, 
give a full dose of bromide potassa and quinine, but if there 
is any jerking of muscles, it will be best to use bromidia, 
or chloral hydrate, with the bromide potassa and quinine. 

Bromidia is composed of bromide potassa, chloral hydrate, 
hyoscyamus and Indian hemp. It is an excellent remedy, 
but one that requires some care in its administration, while 
^he l)romide of potassa alone is a simple remedy, and one 



MALARIAL FEVERS. 



69 



that is in venr general use in this country as a domestic 
remedy for nen'ous headache, etc. 

It is well to use the syringe with injections of Vv'arm water 
and soap, in order to unload the bowels. If no syringe is 
convenient, give a dose of castor oil or salts. 

Unload the bowels, washing out all the foecal matter, — this 
prepares the way for administering medicine by the rectum — 
provided it cannot be given by the mouth. 

Anticipating the spasm, give a full dose of bromide po- 
tassa, — using injections of warm water and soap, in bowels, 
— placing the feet and legs in hot water and mustard, — cold 
applications to head. 

Bromide potassa is a nerve sedative, and will do no harm. 
It is a good remedy to use in treating malarial fevers, as it 
prevents the quinine from causing ner\'Ousness and lessens 
the disagreeable roaring in ears, etc. 

Should the convulsion occur, as it will often do, during 
the height of the fever, the same directions as above should 
be adopted, to-wit : place the patient in a warm bath, or the 
feet and legs in hot water and mustard, applying cold to the 
head ; give bromide potassa, two grs. to a babe one year 
old, adding one grain for each year, and repeat every hour, 
if necessar}^ to quiet ; at the same time, if the stomach will 
tolerate it, give quinine, in dose of one grain to babe one 
year old, adding one-half grain for each year. 

It is well to remember that quinine, in a full dose with 



70 



MALARIAI. FEVERS. 



bromide potassa, will lessen the amount of fever, and al- 
ways administer both when the stomach will tolerate it. 

If unable to administer quinine by the mouth, inject in 
the rectum. A few drops of elixir vitriol will make a ready 
solution of quinine, and it will then pass through the syr- 
inge more readily. 

Before injecting the quinine in the bowels, it is well to 
wash out all the foecal matter first. This can be done by 
using a large injection of warm water and soap ; after the 
patient has passed this, then dissolve the quinine in a small 
quantity of water, with the aid of one drop of elixir vitriol 
for each grain of quinine, and inject the same. 

Washing out the lower bowels first with a large injection 
of warm water and soap, not only prepares the bowels to 
absorb the quinine, but draws the blood from the head, and 
in that manner ma}^ lessen the intensit}" of the spasm. 

Care should be exercised, in attending the little one, to 
avoid ail excitement ; this, in many instances, is difiicult to 
do, for the famil}- and friends are alwa3's greatly alarmed, 
but if the remedies are intelligently administered some one 
must have a cool head to do it, or harm may result. 

Among your domestic medicines it is well to have a mix- 
ture of bromide potassa or the crude salt. , The usual solu- 
tion or bromide is fifteen grains to the teaspoonful of water, 
which is the average dose for an adult. Also chloral hy- 
drate, this keeps better in a weil stoppered (glass) bottle. 
If kept in solution, fifteen grains to the teaspoonful of water 



MALARIAI, FKVERvS. 



71 



is the average dose for an adult. Also a bottle of quinine, 
and a lot of assorted sizes capsules. Capsules are the best 
and most frequent mode of administering quinine. 

Bromidia can be used in lieu of chloral hydrate and bro- 
mide potassa. The dose of bromidiajis one drop for an in- 
fant, increasing the dose one drop for each year, and repeat 
every hour, if necessary to relieve patient. 

Generally there is no need of an emetic, as vomiting is 
frequently a distressing symptom of the fever cases ; how- 
ever, if the stomach is loaded with food, and no vomiting 
takes place, it would be well to produce vom^iting sufficient 
to unload the same ; this can be readily done by one tea- 
spoonful of syrup ipecac to a young child, and repeat in one 
half an hour, if necessar>^ 

RECAPITULATION. 

I. If the spasm occur during the fever (or hot stage) of 
a chill and fever, or remittent fever, place the feet and legs 
in hot water and mustard, (one tablespoonful of ground 
mustard to bowl of hot water ; apply cold water to the 
head ; place a cork (or soft substance) between the teeth (if 
necessary to prevent injury to the tongue) ; give bromide 
potassa and quinine by the mouth ; if not able to admin- 
ister by the mouth, inject in the rectum. If spasms are 
severe add chloral hydrate or bromidia, either by the mouth 
or rectum. 

Repeat the bromide potassa and chloral hydrate every 



72 



MALARIAI, FEVERS. 



hour until the patient becomes quiet and the convulsions 
cease ; at the same time give quinine b}^ the rectum ever}^ 
hour, until the patient begins to sweat freely and the skin 
becomes cool. 

In most cases the bromide potassa and quinine b^^ mouth 
and rectum will soon lessen the amount of fever, and the 
convulsions cease, but if the spasms are severe with much 
jerking, it is always well to give chloral hydrate with the 
bromide potassa. 

The following can be prepared and kept read}- for use 
during the sickly season : 
R Potassa Bromide, 

Chloral Hydrate, a a grs, xxxii 
Water, oz. ii 

M 

Dose (for a child one year old) : one teaspoonful, repeated 
ever}^ hour until the spasm cease. The dose can be increased 
one-half (^) teaspoonful for each 3'ear. The contents of 
the bottle is the dose for an adult. 

The dose of quinine is about one grain for a child one 
year of age, and increase one-half grain for each year. If 
injected into the bowels, double the dose, /. c. two 
grains for one year old babe, and about one-half grain for 
each additional year. A child two years old two and one- 
half grains (by injection) ; three years old three grains, and 
so on. 

To an adult, with a high fever and severe headache, in- 



MAI^ARIAI. FKVERS. 



73 



ject in rectum fifteen to twenty grains. The dose should 
always be much larger by the rectum than by the mouth. 

Remedies are often given hypodermically (under the skin; 
by physicians, but I do not think this safe in the hands of 
the people, consequently will not refer to it in this book. 
None but a physician should ever use a hypodermic syringe. 

Chloroform is often used in relaxing and 'mitigating the 
convulsive movements, but it is not a safe remedy in the 
hands of non-professionals. If used at all, in no case should 
it be given after the convulsive movements cease, but in- 
haled only during the spasm. Fifteen to twenty drops on a 
pocket handkerchief and placed in about three or four inches 
of the nose ; "never place against the nose or mouth, as the 
patient must have pure air with the chloroform." 

Chloroform should always be given with great care, as it 
is a remedy of much power. 

In convulsions of children with malarial fever there is 
seldom need of administering an emetic, as most of the 
cases are attended with obstinate vomiting. 

When the child cannot retain the quinine by mouth or 
rectum, it will be well to appl}^ to the skin. IMix one tea- 
spoonful of quinine with a small portion of lard, or dissolve 
in whisky and apply to the chest and under the arms. 

I have very little confidence in this manner of using 
quinine, but in some instances it will not be retained b}' 
mouth or rectum. 

When the warm bath can be used, it is preferable to bath- 



74 



MALARIAL FEVERS. 



iiig the feet and legs in hot water. The warm water has a 
soothing effect upon the nerv^ous system; promoting mus- 
cular relaxation, and draws the blood from the head, etc. 
The warm bath (with cold water to head) can be repeated 
every two or three hours, as may be necessar^^ 

If quinine is applied to the surface, just after each bath,' 
ivill be the most appropriate time. 



MALARIAL FEVERS. 



75 



MALARIAL TOXEMIA, MALARIAL CACHEXIA, 
CHRONIC MALARIAL POISONING, OR, 
CHRONIC CHILLS AND FEVER. 



SYMPTOMS AND COURSE. 

This condition is caused from repeated attacks of chills 
and fever, or remittent fever. 

The patient is weak without energy, feels debilitated, his 
spleen and liver are enlarged, tongue coated white, and 
shows indentations (on sides) of teeth, no appetite, dyspeptic 
.symptoms, bowels deranged, clay colored discharges, often 
diarrhoea, the skin is jaundiced and flabby. 

There can be no mistaking these cases, the}' are familiar 
to most people in this country. 

Often they have a chill and fever ever>' other day, or they 
may have the fever without any decided chill. 

These cases usually go the rounds, and are prescribed for 
by different ph3'sicians, really not treated by any one, or 
some may, and often do undertake their own case, relying 
on calomel and patent medicines, claiming that they can 
find no remedy to break the ' ' ague. ' ' 

Nothing is more appalling than to see these cases, whose 
systems are saturated with malarial poison, (l^roken down), 
and they continually adding mercurial poison, thus under- 



76 



MALARIAL FEVERS 



mining; nature's lorces : mercur}- in such cases (^malarial 
toxceniia\ is an absolute poison — simply adding fuel to the 
nre. 

These cases of malarial sickness, are no longer simply 
poisoned with malaria, but the malaria has produced or- 
ganic changes in the blood, liver, spleen, stomach, kidneys, 
and indeed the whole system is deranged. 

Parties thus afflicted often try ever^- remedy they can 
hear or read of. buy patent medicines, and after a while con- 
clude there is no virtue in medicine, for the cure of their 
chronic chills and fever; nothing relieves them, and often 
they become desponding. 

Just such cases as these are liable to attacks of malarial 
hemorrhagic fever, and in some few cases dropsy develops. 

While the abdomen in nearly all cases is enlarged, yet 
the outline of the enlarged liver and spleen can be ver\- 
rarely felt. 

The jaimdiced and pale, flabby condition of the skin, in 
these cases of chronic chills and fever, shows the great de- 
struction of the red corpuscles of the blood, and the increase 
of the white. 

The destruction of red blood corpuscles do not take place 
equally in all parts of the body during an attack of malarial 
fever, but seem to spend its force principally in the liver 
and spleen. If the blood suffers in this manner, as a mat- 
ter of course ever>- organ in the body must. 

Sternberg says : 

"The most frequent result of repeated attacks of inter- 



:,IALARIAL FEVERS. 



77 



mittent, or the continued action of malaria not attended 
with febrile manifestations is that condition known as ma- 
larial cachexia I'Toxaemia.) This is characterized by 
anaemia, feeble circulation, impaired digestion, debilit\' and 
an enlarged spleen. 

''In addition to this there is often enlargement and 
functional inactivity of the liver, dropsical effusions, 
mental torpor and in some cases albuminuria. The anaemia 
is often profound : the patient has a blanched appearance, 
the conjunctivae (mucous membrane of the eye), have a 
pearh- lustre, the lips are pallid, and the slightest exertion 
causes d^'spnoea (short breath), and palpitation of the heart. 
Sometimes the skin has a bronzed or icteric ^jaundiced) 
hue. 

TREATMENT OF MALARIAL TOX.^MIA, OR CHROXIC CHILLS 
AXD FEVER. 

All remedies administered should be tonic in character; 
to build up the broken down system, is the grand object : 

The blood is loaded with white corpuscles, when red 
should predominate; iron, in some form, is the best remedy 
for this. Pepsin and muriatic acid to assist in digesting 
the food. 

The policy is to administer remedies to assist in digesting 
and in restoring to the system what is wanting : by which 
means we build up and strengthen the body. 

Anti-malarial remedies alone will not accomplish the 
work in these cases. For the system is damaged by re- 



78 



MALARIAI. FEVERS. 



peated attacks of malarial fevers, and we must restore the 
vital organs to health as well as rid the system of malaria. 
Organic changes have taken place in the liver, spleen, kid- 
neys, and the blood is loaded with impure matter : to some 
extent every organ in the body is affected. 

With a patient in this condition, is it possible by any plan 
of treatment to restore him to health ? 

Almost impossible to do so, and let the patient remain in 
the same atmosphere, the remedies administered will often 
be of no avail — unless the patient can be removed from the 
malarial place. 

When the patient continues to reside in the malarious at- 
mosphere (where he contracted the disease), it is almost 
impossible to cure him; we administer rem^edies during the 
day, and [when night comes, his system takes on a fresh 
supply. His vital powers are at such a low ebb, he cannot 
resist the poison. 

I have used the illustration of a man bitten by a snake, 
and the antidotes given, etc., he allowing the snake to bite 
him again and again, etc., etc, this applies here, for he is in 
just that condition, suffering from repeated attacks. 

He may have taken anti-malarious remedies or not, but 
continues to reside in a malarious region, and is continually 
being poisoned with malaria; suppose he does take quinine 
to neutralize the malaria, and remains in the same locality' 
the struggle is kept up. Soon quinine will have no effect; 
these organic changes have taken place in the various or- 



MALARIAL FEVERS. 



79 



gans of the boch-, and the blood is loaded with effete matter, 
and is no longer good to sustain the s^-stem. 

It is often difficult to convince these half dead people, 
that their systems are being poisoned with malaria — the}" 
will ascribe their chills to the enlarged liver or spleen; want 
something to cure the " ague cake." 

If they should eat some article of food which disagrees 
with them, the}- can recognize this, but when we talk of 
malaria entering the system, and causing chills and fever, 
or remittent fever, they will not believe it. The}- usually 
want something to act on their livers and cure the spleen, 
and often resort to some patent liver regulator, or take 
calomel, which invariabh" does them more harm than good. 

So by all means the first thing is to remove the patient 
from the malarious region. If he can afford it, send him to 
some healthy watering place. But usualh- these cases are 
among the ver}- poorest class; but if only be moved five or 
six miles, will suffice in some instances. If living in the 
swamps go to the hills, or some high elevated place. 

Take a tonic — the following will suffice; it being a com- 
bination of quinine and iron: 

R Quinine Sulph. , grs. lx. 

Fowler's Solution, 5 iss. 
Liq : Oxide Iron, 5 iii. 
Water, q. s., 5 iv. 

M 

DosE: (for an adult.) One teaspoonful three times a day 
(dilute) before meals and through a quill. 



So 



MALARIAL FEVERS. 



If the patient suffers with any dj^speptic S5miptoms, take 
the following : 

R Pepsin, 5 ss. 

Acid Muriatic, (c. p.) 5 ij. 
Glycerine, 3 i. 
Water, q. s., 3 iv. 

M 

Dose : (for an adult.) One teaspoonful just after eating. 
The following is a cheap tonic and a ver}- good one: 
R Quinine Sulph., grs. xxx. 

Tr. Iron, 3 i. 

M 

Dose : (for an adult.) Thirty drops three times a day 
before meals, dihite and through a quill. 

The patient should have a generous diet as he can afford: 
beef, eggs, milk, and a glass of wine after dinne-r, and fail 
not to practice bathing the bod}- well, at least once a da}^ 
in tepid water, adding a teaspoonful of soda to the bath, 
rubbing the skin well, which opens the pores, and assists in 
carr3-ing the poison out of the body. 

Nitro-Muriatic Acid is a good tonic in these cases, after 
using the Iron tonic for some time; the dose (for an adult), 
five drops well diluted, three times a day. 

After using the Iron tonic, or acid, till the appetite is 
fully restored, jaundice disappears. If any enlargement of 
the liver and spleen remains, use a mixture of 



MALARIAI. FKVERS. 



8r 



R Potassa Iodide, grs. xxx. 

Syrup Iodide Iron, 3 i. 

M 

Dose : (for an adult.) Fifteen drops three times a day, 
dilute, through a quill. 

Using an ointment, well rubbed over the liver (of Bin- 
Iodide Mercury) once a day, or paint the surface with Tr. 
Iodine. 

If the patient has any fever or chills, continue to give 
quinine freely, as recommended in the treatment of chills 
and fever. Dose, five grains every three or four hours, until 
he is thoroughly cinchonised, then give fifteen grains daily, 
after he misses the chill, for several days, using the iron 
tonic also. 

All or most of the patent medicines placed on the market 
for the cure of chronic chills and fever, have quinine, or 
some of its alkaloids as their base. 

Some advertise, "no quinine, " and often it is true, but 
the nostrum is saturated with another extract of Peruvian 
bark — Cinchonidia, and really there is very little difference 
between sulp : quinine and sulp : Cinchonidia, so far as ef- 
fect on malarial poison extends. 

Quinine, in many cases, makes the patient more ner\^ous, 
while cinchonidia produces a fullness in the head. 

The author makes no war on the patent medicine men, 
for all of them, so far as he knows, are too smart to put any 
calomel, or any other form of mercury in their compounds — 
and this is a long step in the right direction. However, it 



.82 



MALARIAL FEVERS. 



is to be hoped, that the Congress of the United States will 
some day pass a law forcing patent medicine men to print on 
the label their formula. At the same time they can be pro- 
tected in their compounds, but if people will use patent 
medicines, let them know what they are taking. 

Some ma}^ object to the arsenic in the tonic R prescribed 
on another page, 3'et arsenic in the dose there given, is a 
good tonic in these chronic cases of malarial fever; while in 
large doses it is a well known poison. No fear need be en- 
tertained of its use, in the dose given, even though the 
tonic should be used for at least sixt}' days. 

Usually in these cases diarrhoea is the rule, but if consti- 
pation exists, the same should be overcome by using cascara 
cordial, salts or imp. comp. cathartic pills, syrup rhubarb, 
etc. Use as little purgative medicine as possible ; try and 
regulate the bowels by having a certain hour every day to 
attend to that duty, and when the hour arrives do not neg- 
lect it. There is nothing more conducive to good health 
than a regular condition of the bowels. They should act 
at least once every twenty-four hours. We cannot have 
good health without being regular in our habits. 

If diarrhoea be present, use the pepsin recipe, with black- 
berry cordial or brandy, and, if necessary, give paregoric, etc. 

The following is from a standard work on the practice of 
medicine (Aitken.) It confirms the position taken on this 
-subject, and is in keeping with the views of the leading men 
in the profession : 

" Chronic malarial toxaemia is best treated by a combina- 



MALARIAL FEVERS. 



83 



tion of the chlorides of iron, quinine and arsenic, diuretics, 
mild saline cathartics, ^ ^'^ a nourishing mixed 

diet, including milk, meat, vegetables and fruits, ^ >i< 
and change of climate. Great attention should be paid to 
the skin ; frequent tepid baths should be taken, or the sur- 
face sponged dail}^ ^ -'^ If there is derange- 
ment of the ch^dopoietic viscera (vessels and viscera which 
are connected with the formation of chyli) muriate of am- 
monia alone, or combined wdth chloride potassa and colchi- 
cum, should be given. * 

' 'Under no circumstances should any preparation of mer- 
cury be permitted. * 

"In the treatment of malarial toxaemia it is of first im- 
portance to keep the sluices of the system (the kidneys and 
intestinal canal) open, unless there are contra-indications ; 
and this is best done by the frequent use of the mild saline 
cathartics before named. 

"Chronic enlargement of the spleen frequentl}^ subsides as 
the toxic symptoms abate, and with the general improve- 
ment of health. The special treatment is by bromide of 
potassium and the application of iodine paint. ^ * 

Also the officinal ointment of biniodide of mercury. A 
piece, the size of a nutmeg, is rubbed over the affected or- 
gan. -'^ The patient is then directed to sit 
before the fire until there is a good deal of smarting ; about 
half the quantity is again applied over the tender surface. 
Some blistering follows, which is to be dressed simply. The 
process is repeated in about three weeks, ^' * ^■^ " 



MALARIAI, FKVKRS. 



RECAPITUI.ATION . 

1 . One of the most important things (in the treatment of 
chronic chills) is to remove the patient, if possible, from the 
malarious atmosphere. 

2. If having fever or chills, give a dose of purgative 
medicine, if bowels are constipated. Give quinine freel}^ ; 
dose (for an adult) : five grains every three or four hours, 
until the chill or fever is checked, and the patient thorough- 
ly chinconised, then continue the quinine in five grain doses 
three or four times a day. 

3. Use the iron tonic as soon as the fever ceases. The 
tonic of liq. oxide iron, quinine and arsenic, is one of the 
best for chronic chills. If eye-lids become puffed from its 
use, discontinue the arsenic, and use the quinine and iron. 

4. If bowels are irregular, tr}^ as suggested, to have 
them act at least once every twenty-four hours. Use cas- 
cara cordial or salts for constipation. If any diarrhoea or 
dyspepsia, use the pepsin mixture. 

5. After the system is rid of all malaria and the chills 
checked by the treatment, the liver and spleen should con- 
tinue hard and enlarged, give the iodide potassa and iron 
recipe with the biniodide of mercury or iodine, externall}^ 
as directed, or use the bath of warm water, and soda, with 
nitro-muriatic acid, internally. 

6. Give as good and rich a diet as the patient can afford, 
for good food makes rich blood. 



MAI.ARIAI. FEVERS. 



85 



PREVENTION OF MALARIAL FEVER. 



At no time in the history of medicine has sanitary science 
•attracted so much attention as now. 

The question is, how to prevent disease? and certainly he 
is a more scientific and commendable physician that will 
protect his patients from disease, than one who merely 
cures them. 

People are slow to act, and it is a hard struggle to con- 
vince the masses of the importance of hygiene measures. 
Often not until disease and death have done their fatal work 
among them, can a community see the error of their way. 

As this book treats exclusively of malarial fevers, I will 
confine my paper strictly to the subject, i. e., the "preven- 
^ tion of malarial fevers." 

Again, it will be necessary to review at some length the 
-cause of malaria, because we cannot understand how to 
avoid unless we become familiar with its abode, and how 
generated. Malaria undoubtedly arises from the earh, at 
night, as it is more intense near low, marshy places. 
Surgeon Chas. Smart, U. S. N., in Ref. Med. Sciences, 
says: "In temperate climates marshes, swamps, ditches 
and low grounds subject to overflow by rivers, lakes, ponds, 
etc., afford that conjunction of the factors that is most 
favorable for the evolution of the malarial influence. -i^ 



86 



MAI^ARIAL FKVKRS. 



"The malarial miasm is assumed to arise during the 
retrogression of organic matter to the inorganic state, under 
favorable conditions as to moisture and heat. When the 
moisture is in excess, as when the ground is wholl}^ covered 
with water, there is no malaria. The rainy season in the 
tropics is not the sickly season, but its commencement is, 
v^^hen the sh owners are of short duration, and fall upon a dry 
and parched earth; and also its termination, when the earth 
remains soaked, and covered with a dying and decaying 
vegetation. 

"Fever and ague prevail, not during the period of an inun- 
dation, but during the subsequent period of draining and 
dr^ang up. * ^ * All grounds that are al- 
ternately submerged and exposed, are malarious. 

' ' The artificial draining of ponds, and the accidental 
breaking of dams, have occasioned disease in their vicinit}^ 
'i^ ^' ^ Shallow mill dams that uncover a portion 
of their storage during the use of the water, are more dan- 
gerous than those that have depth enough to keep the land 
submerged. >k * 

. "When a steady wind prevails during the sickl}' season,, 
people living on the windward side may be unaffected, and 
even those to the leeward may be protected by the interpo- 
sition of a strip of forest land. Malaria is diffused into the 
atmosphere with some difficulty. 

"According to Watson, it loves the ground: 'In an un- 
healthy location it is more dangerous to sleep on the 
ground, or on the ground floor, than on the upper floor of a. 



MAI.ARIAI, FKVKRS. 



87- 



house. It is often associated with watery vapor in the 
form of mists, or fogs, which hanging low over the exhalent 
surface, may be floated into neighboring valleys, and up- 
Vv^ard along the rising grounds.' Monfalcon put the dis- 
tance to which malaria could be thus transported, at from 
fourteen hundred to sixteen hundred feet of elevation, and 
from six to ten hundred feet longitudinally Hertz says: 
' We may admit the agency of the wind as a carrier of 
miasm for a short distance, but when it comes to stretches 
of many miles, it is no longer to be taken into account.' 
But the floating cloud of watery vapor and malaria is known, 
to be intercepted by belts of trees. It was remarked by 
Pliny that 'trees destroy or consume the malarial vapors.'" 
There are many instances on record where the planting of a 
belt of trees between a pestilent marsh and a settlement has 
protected the latter from disease; and conversely, where the 
removal of a screen of trees has been followed by an invasion 
of malaria from neighboring swamps. Not trees only, but 
all solid substances appear to attract the malarial poison. 
* * ^-^ Practically, malarial diseases ma}^ be re- 
garded as non-contagious. 

"Besides acting as a screen, trees are generally credited 
with exercising a beneficial influence in malarial localaties. 

"Drainage, however, which removes excess of moisture, 
increases salubrity, while promoting rather than interfering 
with the productive husbandry. Drainage has, therefore, 
from the most ancient times, been recognised as the chief 



•88 



:malarial fevers. 



iiietliod of improving a malarious soil. Malarial fevers have 
been rendered a clinical curiosit}' in England b}' means of 
drainage and systematic cultivation. ^ ^ 
is to be noted, however, that the first efforts at improve- 
ment are almost invariabl}^ followed by an increased viru- 
lence and prevalence of the malarial influence, which sub- 
sides onl}- after a period of continued cultivation. 

"The histor}' of agriculture, in this country, furnishes 
man}' illustrations of febrile outbreaks consequent on the 
drainage, clearing and upturning of the soil; but as these 
districts attain a high state of cultivation, they become pro- 
gressivel}' free from the parox3'smal fevers. >i< ^ 
In fact, it ma}' be said that any marked interference with 
the natural vegetation of a soil is likel}' to induce an en- 
demic of malarial diseases, if the soil presents the concur- 
rence of the three factors considered essential to the emana- 
tion of malaria, viz: heat, moisture and organic matter. 

' ' The evolution of malaria is known by the experience 
of ages to be most active in warm climates and in warm 
seasons, hence the singularity of the fact that the warm 
period of the da}' corresponds in no locality with the great- 
est diurnal activity of the poisonous influence. On the 
contrar}', it is well known that in temperate climates there 
is no danger on marshes that are notorious for their fevers, 
provided the individual be not exposed after night-fall; and 
in tropical climates, jungles ana other pestilential regions 
may be penetrated witli impunity wheri the sun is high in 
the heavens. It may be granted that the resisting power of 



MAI^ARIAIv FEVERS. 



89 



the individual is diminished during an exposure at night, 
particularly during sleep, and that the depressing influence 
of a chilly atmosphere may contribute to still further reduce 
the energy of the ' P^z's conservatrix nahu^cE. ' ^ 
But notwithstanding these considerations, it appears singu- 
lar that the period which should b}' analogy be that of 
greatest exhalation should be that of diminished manifesta- 
tion. The known association of malaria with aqueous 
vapors suggests a coincidence in the exhalation of both from 
the soil; and as the absorption of the latter into the atmos- 
phere is greatest during the heated period, it would seem 
that malarial developments should be corresponding prev- 
alent and intense at that time. In explanation, it has been 
said that when the air becomes chilly, after sunset, the dif- 
ference between its temperature and that of the soil, heated 
by the absorption of the sun's rays during the day, is at its 
maximum, as in consequence the ascensional tendency of 
the air immediately^ in contact with the soil, but radiation 
soon cools the soil to the point where the tendency is to de- 
position of watery vapor rather than to its evaporation, 
while the malarial influences continue as pernicious as 
when the ascensional force was greater. To explain this, it 
has been suggested that during the day- the surface of the 
malarious soil becoming heated in the ray-s of the sun, 
evaporation takes place with rapidity-, and the noxious ex- 
halations carried upward by the ascensional tendency', are 
diluted and dissipated in the higher regions of the atmos- 
phere. There are, therefore, no malarial developments in 



90 



MAI^ARIAL FEVERS. 



the locality. At night, when the direct heat of the sun 
ceases to be felt, the soil speedily evolves its heat by radia- 
tion, the stratum of air in contact with it becomes colder 
than that overlying it, and such exhalations as issue from 
the soil are stayed in their upward course in the stagnant 
layers of cold and moist air which first receive them; hence, 
although emanation is more active during the day than at 
night, the state of condensation of the miasm is so much 
greater during the latter period, that pernicious effects are- 
only then attributed to it. 

' ' The utility of large fires in dissipating malaria, or in 
protecting from its evil consequences, has been long a set- 
tled belief. Hippocrates considered that protection was 
thus attained, and in modern times troops operating in 
unhealthy sections have resorted to this as an agreeable 
preventive measure. 

' 'The generally accepted theory of malarial evolution calls, 
for the concurrence of an organic soil, a certain degree of 
heat, and a certain proportion of moisture." 

In the further discussion of this subject — prevention of 
malarial fevers — I will quote at some length from the works 
of Prof. Joseph Jones, of New Orleans, one of the best 
authorities on the subject of malaria, etc., etc. — a man who 
has spent a lifetime in the clo.se study and investigation of 
the diseases of the South, and has given us a work that will 
remain long after he is dead, as a monument of a useful 
and well spent life. The labor expended by Dr. Jones is 



MALARIAL FEVERS. 



9^ 



immense, and evety Southern physician should have a copy 
of his works. He sa^-s : 

"No subject is of greater importance to the inhabitants 
of the tropical and temperate regions of the earth than the 
destruction or removal of the cause or causes of malaria. 
The following propositions should be considered in the dis- 
cussion of the measures which may be proposed for the de- 
struction or rem^oval of causes of malaria : 

Firsf. ' 'Malaria inflicts a vast amount of disease and suf- 
fering upon the human race, and directly and indirectly causes 
a considerable portion of the mortalit}' in the tropics and 
temperate climates. The star of empire, which has been 
steadily passing from the east to the west, has halted in its 
progress in the great valley of the Mississippi, where it will 
remain as the center of political power, physical develop- 
ment and scientific advancement. In those regions in vrhich 
the earth gives malaria, she also bestows her most bounteous 
gifts : golden grain, lucicus fruits, and even.' variety of 
animal and vegetable food. Thus the baneful effects of 
malaria are counter-balanced, to a large extent, by the mild 
and genial climate, and the bounteous products of field and 
forest, river, lake and ocean." 

Second. ' ' The labors of man in clearing the forest, 
opening and deepening the channels of rivers, draining and 
tilling the land, have altered the climate and changed the 
character of the diseases of large portions of the earth's 
surface. The malarious belt of the earth has been thus 
progressively circumscribed by the labors of the agricul- 



92 



MALARIAL FEVERS. 



turist. In the present centur\- the removal of the causes of 
malarial fevers has been greatly facilitated b}' extensive in- 
troduction of improved implements and machiners', and the 
use of steam. The drainage of lagoons, swamps and 
marshes, as well as the land generalh', has removed certain 
conditions favorable to the development of simple con- 
structed organisms and morbific ferments. With the in- 
crease of the human race and the advancement of agricul- 
ture and the mechanical arts, there will be a progressive 
diminution of the empire of malaria." ^-^ ^ ^'^ 

Thiid. " Centuries must elapse before the low grounds, 
marshes, ponds, lagoons and swamps of the United States 
of America, and more especialh' of the great valley of the 
Mississippi, will be thoroughly drained and under cul- 
tivation." 

Fourth. "Substitute cistern water for well or spring 
water. ' ' 

There can be no doubt that man}' cases of malarial fevers 
are caused from the drinking of water from shallow wells, 
springs, or cisterns that leak. Look well to the supph^ of 
water used for drinking purposes. 

Fifth. ' ' Never commence work upon an empty stomach. ' ' 
" Avoid as far as possible, the dews of the morning and 
nights." 

" Avoid wet clothes as far as possible." 
In reference to building houses, care should be exercised 
in .selecting the location. 

In this State (Texas), it is well to always build 0!i the 



.lALARIAL FEVERS. 



93 



south side of the river, lake or low marshy places, as the gulf 
breeze which is always from the south, will carr}* the ma- 
laria away from the residence. 

The question is often asked why does Mr. A"s family es- 
cape fevers, while B"s, living in the same neighborhood, is 
alwa3's sick ? Many times it can be accounted for in the lo- 
cation of the residence. One on the north, and one on the 
south of a malarious place, or it may be one has a screen of 
timber inter\'ening. 

» Man\' farmers in this country build their tenant houses in 
the fields and cultivate the land close to the building. This 
is wrong. Cotton is an unhealthy plant ; especially is this 
true, if it has been attacked hy worms, or has shed the 
leaves freel}'. Chills and fevers will certainly attack any 
one who resides in a cotton field, when this is the case. 
Heat, moisture and vegetable decomposition are there, and 
these are all that is necessar}' to produce malaria. 

Allowing weeds and rank vegetation to grow in close 
proximity to the building, cutting the same down and per- 
mitting it to decay, will cause malaria. If cut, it should be 
destroyed by fire. 

Two-stor\' houses are much better than the low buildings, 
if the upper story be occupied at night, for the poison hov- 
ers near the ground, as has been shown. When the weather 
will permit, close the doors and windows after lo p. m., but 
often in this countn.- the weather is so hot that we cannot 
bear the placing of ourselves in a hot box by closing the 



94 



MALARIAL FEVERS. 



doors and \Yindows at night. Nor is this advisable when 
several persons occupy the same room. 

As a preventive, quinine is the best of all known drugs. 
I do not think whisk}- or strong drink is of any benefit, as 
many seem to think in this countr3\ There is certainly 
more virtue in ten grains of quinine than in one gallon of 
whisky to prevent an attack of malarial fever. 

There is no doubt in the minds of the yery best authori- 
ties in this country' as to the power of qunine to ward off an 
attack of malaria. One says : "Of the prophylactic virtues, 
of quinine against malarial impressions, it may be asserted 
with confidence that, fortified w^ith this wonderful drug, 
none need fear venturing at any time into the heart of our 
hostile low-lands in summer, inhaling with impunity its 
deadly miasma." 

I am inclined to think this language is too strong, 3-et 
there is much truth in it, for quinine is the great anti-mala- 
rial drug. Let the S3'stem be kept under its influence while 
in a malarial region. 

When possible, have a screen of green timber between the 
dwelling and the place supposed to be malarious, and by no 
means allow the sanie destroyed. 

Often I have known a healthy place made malarious b}^ 
the cutting away of a skirt of timber between the house and 
the swamp. 

In this countr>^ on the prairies, I do not think it well to 
have too many shade trees in close proximity to the house ; 



MALARIAL FEVERS. 



95 



they keep the ground too damp and are always full of mos- 
quitoes. 

Occassionally burning the trash and refuse about the 
place prevents malaria as well as other sickness, as the fires 
not only destroy- the garbage, trash, etc., but purify the air. 

JlECAPITULATIOX. 

1. We must build our houses, when possible, on the 
south side of these creeks, ponds and malarious places, and 
on as high an elevation as can be secured. The}- should be 
far enough above the ground to admit the air to pass freel}^ 
under them. AVhen the part}- building can bear the ex- 
pense, an upper stor}- should always be added, and occupied 
as a sleeping appartment during the time that malaria pre- 
vails. 

2. Avoid building in the fields where the house will be 
surrounded by rank vegetation, and the land cultivated in 
close proximity to same. 

3. If possible keep a screen of green timber between the 
house and the low malarial places, and if no forest exists, it 
will pay to plant trees. 

4. When the weather will permit, close the windows and 
doors after 10 p. m. 

5. Avoid sleeping in the night air or exposing the per- 
son early in the morning dews, etc. 

6. Use pure cistern water when possible, which should 
by all means be caught during the winter. It seems it will 
be many years before the people of this State will learn the 



96 



MALARIAL FEVERS. 



value of good and pure Avater, and how essential it is to 
health. Often they find water so full of chemicals and so bad 
that an animal will not drink it ; the}^ build a hotel and 
establish a health resort, advertising the wonderful proper- 
ties of the springs or wells. 

7. Take from three to five grs. of quinine at least once 
a day, and if an}^ lassitude, aching of bones, excitement of 
pulse, with flashes of heat, are felt, take three grs. three or 
four times a day. "An ounce of prevention is worth a 
pound of cure," — ten grs. of quinine is better to ward off 
an attack than thirty grs. given to cure. If the bowels are 
constipated, take salts or cascara cordial to act on same. 

8. Occasionally have the yard and premises cleaned and 
all the trash and filth burned, and do not forget that an oc- 
casional bath is necessary to make the skin act well, for it 
has been well said that "Cleanliness is next to godliness." 




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